[Epilepsy and depression]

Abstract

Background: Episodic depression is more prevalent among persons with epilepsy than among those without. In many of these patients, depressions affect the quality of life more severely than the seizures themselves.

Material and methods: The article is based on literature identified through a non-systematic search in PubMed, and the authors' own clinical experience with this patient group.

Results: Diagnosing depression in patients with epilepsy may be difficult, because the symptoms are somewhat atypical and appear episodically. Depressive symptoms may be temporally related to seizures (ictal or periictal), or more often - independent of them (interictal). The causes may be of neurobiological, psychosocial or iatrogenic nature. Patients who have temporolimbic epilepsy, a focus in the left hemisphere, and/or who take GABAergic drugs, seem to be particularly vulnerable. Antidepressants can in some cases reduce the seizure threshold, but SSRIs and SNRIs do this to little or negligible extent. These drugs are therefore recommended as first-line treatment for depression in patients with epilepsy.

Interpretation: There is a bidirectional relationship between epilepsy and depression, as both conditions increase the risk of developing the other. This phenomenon may be explained by accumulating evidence of pathophysiological mechanisms common to them both. Depression is frequently overlooked in patients with epilepsy, and accordingly not treated. We believe measures such as pharmacological treatment and/or cognitive, behavioral, and interpersonal therapy may improve the quality of life for these patients.