Depressive Disorders in Patients with Epilepsy: Underdiagnosed and Appropriately Managed?

Epilepsy is a complex disorder that is commonly associated with additional brain dysfunction, social isolation, and vocational difficulty. Each of these factors may contribute to the increased prevalence of psychiatric disorders in epilepsy. Yet, epidemiological data suggest that depression is the most prevalent disorders among all psychiatric illness in epilepsy. Likewise, several emerging data have explored several multifactorial etiologies of depression in epilepsy. These include underlying genetic, neurochemical, anatomical, neurologic, and iatrogenic factors. Furthermore, clinical investigations have consistently demonstrated that depression has a large impact on subjective health status. In patients with recurrent seizures, depression appears to have a stronger association with QOL than does seizure rates. Unfortunately, however, a significant proportion of patients with epilepsy and depression are not diagnosed nor offered the appropriate treatment. Current treatment recommendations for depression in epilepsy are similar to those for otherwise neurologically normal depressed patients, emphasizing the role of SSRI, but certain antidepressants should be used with caution. Ongoing studies are attempting to define optimal treatment strategies, and more definitive data to guide clinical management is expected to become available in the near future.