title: Managing depressive disorders in patients with epilepsy.
abstract: Patients with epilepsy are more likely to suffer from psychiatric illnesses, and more specifically depressive disorders (9% to 22%), than the general population. Depression in epilepsy is often described by the temporal correlation to a seizure, with interictal depression being the most commonly described. Furthermore, epileptic patients with depression often report a poorer quality of life on global assessments and are at an increased risk of suicide as compared to the general population, 11.5 percent versus 1.2 percent, respectively. Despite the clinical significance of depression, it often goes unrecognized and hence untreated in this population. Recently, more efforts at screening epilepsy patients for coexisting depression have been undertaken, yielding fair results. However, some epilepsy patients express a certain constellation of symptoms, including an explosive or irritable mood, somatic pains, anxiety and fear, and periods of brief euphoria, which are not captured by common depression screening tools. Fears of antidepressants lowering seizure thresholds coupled with potential pharmacokinetic interactions between antiepileptic and antidepressant medications have strongly contributed to the undertreatment of this population. Finally, the treatment of depressive disorders in epilepsy is understudied and the few existing research studies have yet to display an effective treatment. Depressive disorders in patients with epilepsy pose significant and specific problems with regard to recognition, diagnosis, and treatment that require careful and thorough management.
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
authors.forename: Ben T
authors.initials: BT
authors.lastname: Kurian
references.citation: Epilepsia. 2004 May;45(5):544-50
references.pmid: 15101836
references.citation: Epilepsy Behav. 2000 Apr;1(2):100-105
references.pmid: 12609138
references.citation: Epilepsy Behav. 2003 Oct;4 Suppl 3:S31-8
references.pmid: 14592638
references.citation: Can J Psychiatry. 2005 Mar;50(4):195-202
references.pmid: 15898458
references.citation: Epilepsia. 2002;43 Suppl 2:37-44
references.pmid: 11903482
references.citation: J Gen Intern Med. 2001 Sep;16(9):606-13
references.pmid: 11556941
references.citation: J Neuropsychiatry Clin Neurosci. 2005 Spring;17(2):172-9
references.pmid: 15939970
references.citation: Epilepsy Behav. 2000 Dec;1(6):444-447
references.pmid: 12737834
references.citation: Behav Res Ther. 2003 Apr;41(4):447-60
references.pmid: 12643967
references.citation: Arch Gen Psychiatry. 1961 Jun;4:561-71
references.pmid: 13688369
references.citation: Epilepsy Behav. 2003 Dec;4(6):674-9
references.pmid: 14698701
references.citation: Epilepsy Behav. 2004 Dec;5(6):826-40
references.pmid: 15582829
references.citation: Epilepsy Behav. 2003 Aug;4(4):441-6
references.pmid: 12899867
references.citation: J Clin Psychiatry. 1998;59 Suppl 20:22-33;quiz 34-57
references.pmid: 9881538
references.citation: Biol Psychiatry. 2003 Sep 1;54(5):573-83
references.pmid: 12946886
references.citation: Int J Clin Pract. 2005 Dec;59(12):1435-40
references.pmid: 16351676
references.citation: J Neuropsychiatry Clin Neurosci. 2005 Winter;17(1):20-8
references.pmid: 15746479
references.citation: Drug Saf. 1998 Feb;18(2):125-33
references.pmid: 9512919
references.citation: J Clin Psychol. 1984 Jul;40(4):930-5
references.pmid: 6434595
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002029
references.pmid: 16235293
references.citation: J Clin Psychiatry. 1997 Jan;58(1):3-11
references.pmid: 9055830
references.citation: Epilepsia. 1986 May-Jun;27(3):225-33
references.pmid: 3516668
references.citation: Epilepsia. 1999;40 Suppl 10:S48-56
references.pmid: 10609604
references.citation: Am J Epidemiol. 1977 Sep;106(3):203-14
references.pmid: 900119
references.citation: Psychol Med. 2004 Jan;34(1):73-82
references.pmid: 14971628
references.citation: Neurology. 1999;53(5 Suppl 2):S26-32
references.pmid: 10496231
references.citation: Br J Soc Clin Psychol. 1967 Dec;6(4):278-96
references.pmid: 6080235
references.citation: Neurology. 2004 Jan 27;62(2):258-61
references.pmid: 14745064
references.citation: Arch Neurol. 1995 Oct;52(10):997-1003
references.pmid: 7575228
references.citation: J Affect Disord. 1985 Sep;9(2):127-36
references.pmid: 2932485
references.citation: JAMA. 2003 Jun 18;289(23):3135-44
references.pmid: 12813119
references.citation: Br J Psychiatry. 1979 Apr;134:382-9
references.pmid: 444788
references.citation: Epilepsy Behav. 2005 Sep;7(2):305-10
references.pmid: 15996526
references.citation: Epilepsia. 2004;45 Suppl 2:28-33
references.pmid: 15186342
references.citation: Natl Vital Stat Rep. 2006 Apr 19;54(13):1-120
references.pmid: 16689256
references.citation: Clin Neuropharmacol. 2004 May-Jun;27(3):133-6
references.pmid: 15190237
references.citation: CNS Drugs. 2002;16(5):291-302
references.pmid: 11994019
references.citation: J Clin Psychiatry. 1993 Aug;54(8):289-99
references.pmid: 8253696
references.citation: J Clin Psychiatry. 1998 Dec;59(12):690
references.pmid: 9921708
references.citation: Epilepsia. 2005 May;46(5):731-5
references.pmid: 15857440
references.citation: Epilepsy Behav. 2006 Mar;8(2):411-7
references.pmid: 16466966
references.citation: Epilepsy Behav. 2003 Oct;4(5):515-21
references.pmid: 14527494
references.citation: Epilepsia. 2000;41 Suppl 2:S31-41
references.pmid: 10885738
references.citation: Epilepsy Behav. 2001 Oct;2(5):481-489
references.pmid: 12609287
references.citation: Epilepsia. 2002;43 Suppl 2:14-8
references.pmid: 11903477
references.citation: Neurology. 1983 May;33(5):646-8
references.pmid: 6682502
references.citation: Neurology. 1987 Sep;37(9):1525-7
references.pmid: 3627451
references.citation: Epilepsy Behav. 2004 Jun;5(3):337-42
references.pmid: 15145303
references.citation: Epilepsy Behav. 2003 Dec;4 Suppl 4:11-9
references.pmid: 14654423