Wednesday, September 24, 2008

Epilepsy Foundation: Mood Disorders and Victor Newman ...

I'm home today, sick with a cold, and I thought I'd tune in to the soap I watch occasionally.  Imagine my surprise when I realized that, two months later, "Victor" is still incapacitated with grief over the death of his latest wife ... he says he feels "empty" ... he's quitting everything and giving away everything else.  Hey, the dude is depressed and suicidal!  Could it be that the soaps are going to start bringing some intelligent script writing to mental illness?  So I turned to my trusty Google ... it's not much, but it's a start! Dr. John Barry discusses the impact of mood disorder in the life of "Victor Newman"

Barry, M.D., is an associate professor of Psychiatry and Behavioral
Sciences at Stanford University Medical Center. After reading a section
of the script for episodes of The Young and the Restless dealing with epilepsy, EpilepsyUSA spoke to him about the changes in mood of Victor Newman, the character diagnosed with temporal lobe epilepsy.

What can you tell us about mood disorder as it relates to epilepsy?

are a number of people with epilepsy who experience disagreeable
changes in their emotions. In fact, while the link between mood
disorders and epilepsy has been observed for more than 2,000 years, the
relationship between seizures and mood disorders has not been well
understood. Today, we don't have all the answers, but we do know mood
disorders occur more often in people with epilepsy than in the general

Unfortunately, mood plays a critical role in the
ability of people to perform a variety of daily activities. People with
epilepsy may be experiencing a mood disorder when feeling anxious,
depressed, irritable, or have feelings of fear, panic, or pain that are
not easily explained by seizures or other medical causes. Depression is
the most common mood disorder experienced by people with epilepsy and
may affect up to a third of people with uncontrolled seizures.

some people become depressed, others may become irritable. Some people
have milder forms of depression that may also affect quality of life
and response to treatment. Anxiety, while not technically a mood
disorder, is another common emotion that occurs more often in people
with epilepsy. In order to improve the quality of life for people with
epilepsy, it's very important for both doctors and patients to be
familiar with the commonly encountered problems of mood disorders.

a lot of people with refractory seizures, the impact of mood disorders
on their lives is at least as important as their epileptic events.
Therefore, they should receive the same attention to treatment. If
someone has a mood symptom affecting their usual activities, they
should tell the doctor and consider seeing a mental health professional
to be screened for depression. It's important to realize that
antiepilepsy drugs (AEDs) and brain dysfunction can sometimes cause
similar symptoms and mimic depression. A health professional should be
able to sort out the cause of the feelings, however.

What can you say about the epilepsy symptoms associated with the character, Victor Newman?

doctor in the television program diagnosed the character with epilepsy
as having a simple partial seizure. However, because he has experienced
periods of unconsciousness, he may very well have complex partial
seizures instead.

Regardless of the character's diagnosis, I am concerned that viewers of the
program could believe that epilepsy creates a heightened sense of well
being. This is not what I see every day with people who are
experiencing the kind of mood disorders that are associated with

While some of the first aid information presented in
the program appears quite accurate, the character's condition is not
very realistic and is certainly not very common. People with some forms
of epilepsy may experience auditory hallucinations, such as hearing
sounds as well as visual experiences. This may occur as an ictal event
or more commonly as a post-ictal phenomena, especially after a flurry
of seizures.

Could the character's mood disorder improve with his treatment for epilepsy and seizures?

are the most obvious part of having epilepsy, but they may not be the
only part. A brain injury – such as a head injury, meningitis,
stroke, or brain tumor – that is causing the seizures may also
cause mood problems. A mood disorder, like depression, is likely to
decrease someone's quality of life. For example, symptoms that occur
with depression such as irritability and sadness may interfere with
social relationships, and trouble sleeping may even make seizures
worse. Depression can sometimes be very severe, leading to thoughts of
death or suicide. So, it's important for people experiencing these
symptoms to share their feelings with a health care provider because
there are many effective treatments for mood disorders associated with

Some AEDs may help to improve mood, but their primary
purpose is to control the seizures. Other AEDs, however, may be
associated with depression or worsen an underlying depression.
Unfortunately, it's difficult sometimes to determine whether the
medication or the underlying brain dysfunction is responsible for
abnormal mood. Often times the temporal relationship of starting an AED
and the onset of a mood disorder will give a helpful hint.
Psychotherapy and medication are the mainstays of treatment. The goal
is to completely eliminate the symptoms.

If you were writing the story, how would you have portrayed the character?

portrayal of the character is unfortunate since a rare or unusual
appearance of a seizure disorder is being portrayed as the norm. First,
I would want the viewers to realize that having epilepsy is not a
desirable condition. Secondly, I see people with epilepsy every day and
many of them have very fascinating, admirable and interesting stories
that deserve to be told and do not require such a stretch of
imagination. For example, I might describe someone who has had a severe
head injury and developed epilepsy and their subsequent depression and
personal and family struggles to get care and find employment. The very
common and typical experiences of people with epilepsy are often
dramatic and display the immense concern and sacrifice that families
freely extend to one another. You don't have to make up such an unusual
symptom complex to find a fascinating story line. It's not necessary.
The real lives of people with epilepsy are often very dramatic without
any exaggeration. Alternatively, the major character could have
developed epilepsy in a more common fashion and sustained a steep
decline in his overall functioning that was ameliorated by effective

What could happen next to the character?

the character continues to have seizures and refuses his medication, he
could have a generalized convulsion. In addition, if his mood symptoms
are a post ictal phenomena, certainly they may worsen and cause more of
a functional difficulty for both the character and his family. The
symptoms that he is having may not be so desirable at that point and
treatment may become more obviously necessary and agreed upon by the

Unfortunately, if the character decides to start
taking his medication as prescribed and then reverts back to his
less-desirable personality, we're really sending the wrong message
about people with epilepsy. It's just not what happens in the real
world. Most of the initial seizures experienced by people who develop
epilepsy are neutral in their presentation and may be even "invisible"
to most others. They are certainly not associated with such an enviable
sense of calm and peacefulness that is being portrayed here.

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