Depression in epilepsy: why aren't we treating?

Depression is a common and largely untreated comorbidity in patients with epilepsy. Our aim was to examine physician attitudes that may contribute to this treatment gap. We surveyed primary care physicians, neurologists, and psychiatrists chosen from the Ohio State Medical Board registry on the topics of depression in epilepsy, seizures with antidepressant use, and comfort in treating depression in epilepsy. Our data identified fear of increased seizure frequency with antidepressant use as a significant barrier to treatment. There was a clear inverse relationship between the estimated risk of antidepressant-induced seizures and comfort treating depression in epilepsy (P = 0.02), with 52% of primary care physicians identifying this as a reason for not treating depression in this population. Further education of community physicians and neurologists regarding the importance of treating depression in patients with epilepsy and research into the use of antidepressants in this population are indicated.