ABSTRACT

Major depression represents a frequent psychiatric comorbidity among patients with epilepsy but it often remains unrecognized and untreated. Among the potential neurobiological and psychosocial determinants, epilepsy-related variables such as an early age at onset of seizures, the involvement of limbic structures, a high seizure frequency as in drug-refractory epilepsy, play a relevant role. Moreover, the psychotropic potential of the antiepileptic drug medications needs to be carefully considered. The diagnosis of depression in epilepsy can be challenging because the clinical phenomenology is, more often than not, atypical and polymorphic. Finally, data on pharmacotherapy of depression in epilepsy are still limited with no controlled clinical trials. The potential worsening of seizures during antidepressant drug treatment represents a significant concern.