Depression in epilepsy: mechanisms and therapeutic approach

In patients with epilepsy, mood disorders represent a frequent psychiatric comorbidity but they often remain unrecognized and untreated. However, comorbid depression may have a major impact on the quality of life of patients with epilepsy, sometimes even more than the seizures. Among the potential neurobiological and psychosocial determinants, epilepsy-related variables (age at onset of seizures, temporal lobe epilepsy and frequency of seizures) and the antiepileptic drug treatment have been associated with depression. Nonetheless, data on treatment strategies are still limited with a lack of controlled trials on the use of antidepressant drugs. Moreover, the issue of psychotropic drug treatment of depression in epilepsy is interlinked with that of worsening seizures. This paper is aimed at discussing all these subjects in the light of current literature on the neurobiology of depression in epilepsy.