Pharmacological treatment of anxiety disorders in adults with epilepsy

Anxiety disorders represent one of the most frequently encountered comorbidities in patients with epilepsy, affecting the quality of life and increasing, morbidity, mortality, and healthcare costs. However, they are still underdiagnosed and undertreated.

This is a narrative review of the pharmacological treatment of anxiety disorders in adult patients with epilepsy discussing also major issues regarding pathophysiology and diagnosis.

There are a lack of studies concerning the treatment of anxiety disorders in epilepsy, which is a serious gap in the literature. There is an urgent need for treatment and outcome data in order to provide information to patients. Current evidence outside epilepsy focuses on Selective Serotonin Reuptake Inhibitors and  Serotonin Noradrenalin Reuptake  Inhibitor with strong evidence especially for the acute and long-term treatment of Generalized Anxiety Disorder and Social Anxiety Disorder. Although it is reasonable to adopt treatment guidelines outside of epilepsy, it is completely unknown whether anxiety disorders in people with epilepsy have the same response and remission rates observed outside epilepsy. Future research strategies for new drug treatments in epilepsy will probably take comorbidities into account. At this point, pregabalin and buspirone represent an interesting starting point for the development of new compounds potentially indicated in both conditions.