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Systematic screening for antiepileptic drug side effects may increase identification of toxicity and guide medication changes to reduce adverse effects and possibly improve subjective health status.

Background: Adverse effects (AEs) of antiepileptic drugs (AEDs) are a major impediment to opti-

Summary:Epilepsy is a chronic disorder that adversely affects social, vocational, and psychological functioning. Despite the variety and complexity of the negative clinical associations with epilepsy, depression is remarkable in prevalence and related adverse effects on health status. An estimated 30-50% of persons with refractory epilepsy have major depression, and depression has a stronger correlation than seizure rate with quality of life. Suicide is one of the leading causes of death in epilepsy. Available data indicate that depression may result from underlying brain dysfunction rather than social and vocational disability. Most patients with depression are not screened systematically for the diagnosis, and are subsequently not treated. Although the density of serotonin receptors is greatest in limbic brain regions commonly involved in human epilepsy, such as the mesial temporal and prefrontal areas, no prior randomized controlled trials have evaluated the efficacy of serotonin reuptake inhibitors for depression in epilepsy. Key Words: Epilepsy-Depression-PET-Quality of life-Seizures-Functional imaging.Epilepsy is a chronic disorder that has complex interactions with social, vocational, and psychological functioning. Although multiple epidemiological studies indicate that depression is a common comorbid condition in persons with epilepsy, the relative contributions of social and vocational disability compared to limbic system injury are not known (1). Many common syndromes, such as temporal lobe epilepsy and frontal lobe epilepsy, are associated with injury or dysfunction in brain regions implicated in the etiology of depression based on density of serotonin receptors. Despite the plausibility of the variable efficacy of serotonin-reuptake inhibitors related to limbic system responsiveness, few randomized controlled trials of the treatment of depression in epilepsy are published (2).The consequences of depression in persons with epilepsy have not been fully examined. Some clinical studies have suggested synergistic negative effects of epilepsy and depression on various aspects of health status, and suicide is one of the leading causes of death in epilepsy. Although depression appears to be highly prevalent in epilepsy and has significant consequences, available data indicate that most patients with depression are not screened or treated. This article reviews the available information regarding the etiologies of depression in epilepsy and current standards of care to offer areas for PREVALENCE OF DEPRESSION AND SUICIDE IN EPILEPSYThe prevalence of depression ranges from 20 to 55% in patients with recurrent seizures and from 3 to 9% in patients with well-controlled seizures, based on available epidemiological studies. In an inpatient sample in a video/EEG seizure monitoring unit, Boylan et al. (3) found that 50% were depressed, 19% had recent suicidal ideation, and only 17% were being treated with an antidepressant medication. Mendez et al. (4) used the Hamilton Depression Rating Scale in 175 consecutive p...

Lamotrigine produces significantly fewer untoward cognitive and behavioral effects compared to topiramate (TPM) at the dosages, titrations, and timeframes employed in this study. The dosages employed may not have been equivalent in efficacy. Future studies are needed to delineate the cognitive and behavioral effects of TPM at lower dosages.