The Link between Mood Disorders and Epilepsy: Why Is It Important to Diagnose and Treat?*

Depression commonly is comorbid with epilepsy and, of the depressive disorders, major depression is most common. Depression is often comorbid with an anxiety disorder (eg, generalized anxiety, social phobia, post-traumatic stress disorder, panic disorder, or obsessive-compulsive disorder), in the general public and in persons with epilepsy (PWE). This discussion will focus on mood disorders in PWE and treatment options for those adult PWE with a unipolar mood disorder. The presentation of mood disorders forms a spectrum across patients. Mood disorders remain undiagnosed and undertreated in PWE, in part, because many healthcare providers think these disorders are a normal reaction to a chronic illness. However, recent epidemiologic studies suggest that the relationship may be bidirectional (ie, causal instead of merely comorbid), but the nature of this relationship is unclear. Undertreating depression in PWE not only jeopardizes patients’ psychiatric health but also undermines the patients’ ability to habituate to their medical illness or follow and comply with treatment regimens. Depression in epilepsy also has been shown to decrease the patient’s quality of life and increase the patient’s risk for suicide. Therefore, it is important to continue research into the mechanisms of mood/anxiety disorders and epilepsy and to make their diagnoses a higher priority in the management of PWE. There are limited evidence-based data for treating depression specifically in PWE. However, the psychiatric literature provides a framework for treatment strategies. As with treatment of depression in the general public, total remission is the treatment goal because residual symptoms are strong predictors of relapse. (Adv Stud Med. 2005;5(6C):S572-S578)