Diagnosis and Treatment of Depression in Patients with Epilepsy

Depression has not been highlighted in the field of epilepsy research and treatment despite its harm-ful effects on patients’ daily living. Depression in patients with epilepsy is still underrecognized and undertreated by neurologists due to a lack of training about the psychiatric aspects of neurological disorders, lack of knowledge about the management of depression and the use of antidepressants, lack of time in the outpatient setting, misconceptions about seizure risk with psychotropic medications, and lack of communication with psychiatrists. Therefore, it is critical to acknowledge depression in patients with epilepsy through education and the application of screening tools and establish evidence-based medicine for its treatment. The Neurological Disorders Depression Inventory for Epilepsy is the most efficient and practical screening tool for depression and is also effective to de-tect suicidality in patients with epilepsy. The International League Against Epilepsy recently provided practical recommendations for the treatment of depression in patients with epilepsy. For mild depression, psychotherapy is the first-line treatment, and where medication is used, selective serotonin reuptake inhibitors (SSRIs) are first-choice medications. For moderate to severe depression, SSRIs remain the first-choice medications and psychotherapy can be combined with antidepressants. An-tidepressant treatment should be maintained for at least 6 months following remission from a first depressive episode but it should be prolonged to 9 months in patients with a history of previous epi-sodes and should continue even longer in cases of residual symptomatology until such symptoms have subsided and in those with severe depression.