The recognition and management of mood disorders as a comorbidity of epilepsy.

Mood disorders, especially as a comorbid finding in people with medical disorders in general, and in those with epilepsy in particular, have become increasingly recognized as a serious health concern. Unfortunately, affective disorders are underrecognized, and appropriate treatment is infrequent. The consequences of poor detection of mood disorders in people with epilepsy are discussed, along with a review of risk factors and the appearance of the disorder in this population. Prevalence rates of both depressive and bipolar spectrum disorders in people with epilepsy appear to be higher than in the general population. Recent data from community samples show elevated rates of both disorders in people with epilepsy, significantly above those in people with and without other chronic diseases. Assessment issues, including the positive and negative side effects of antiepileptic drugs, are reviewed. Treatment options are discussed, along with caveats concerning the use of antidepressants in people with epilepsy, with a focus on safety, utility, and drug interactions. Electroconvulsive therapy can also be used safely in people with epilepsy, and vagus nerve stimulation may have some utility in the treatment of depressive disorders as well. However, despite improved detection methods and effective treatments, implementation of this knowledge in neurology outpatient clinics is still problematic.