Managing depressive disorders in patients with epilepsy.

Patients with epilepsy are more likely to suffer from psychiatric illnesses, and more specifically depressive disorders (9% to 22%), than the general population. Depression in epilepsy is often described by the temporal correlation to a seizure, with interictal depression being the most commonly described. Furthermore, epileptic patients with depression often report a poorer quality of life on global assessments and are at an increased risk of suicide as compared to the general population, 11.5 percent versus 1.2 percent, respectively. Despite the clinical significance of depression, it often goes unrecognized and hence untreated in this population. Recently, more efforts at screening epilepsy patients for coexisting depression have been undertaken, yielding fair results. However, some epilepsy patients express a certain constellation of symptoms, including an explosive or irritable mood, somatic pains, anxiety and fear, and periods of brief euphoria, which are not captured by common depression screening tools. Fears of antidepressants lowering seizure thresholds coupled with potential pharmacokinetic interactions between antiepileptic and antidepressant medications have strongly contributed to the undertreatment of this population. Finally, the treatment of depressive disorders in epilepsy is understudied and the few existing research studies have yet to display an effective treatment. Depressive disorders in patients with epilepsy pose significant and specific problems with regard to recognition, diagnosis, and treatment that require careful and thorough management.