Depression is the commonest comorbid psychiatric condition in epilepsy. 1 The relationship between epilepsy and depression was described as far back as 400 BC by Hippocrates. 2 Studies have consistently shown a higher prevalence rate of depression in patients with epilepsy compared with the general population. 3 In a Canadian population-based study, authors reported an estimated lifetime prevalence of mood disorders of 24.4 per cent in individuals with epilepsy, compared to 13.2 per cent in those without. The lifetime prevalence of major depression was 17.4 per cent in those with epilepsy compared to 10.7 per cent in people without epilepsy. 3 Other psychiatric disorders including anxiety, bipolar disorder and suicidal ideation were also more common in the epilepsy group. Higher prevalence rates of up to 48 per cent have been reported in tertiary centre-based studies. 3 These patients were more likely to have refractory epilepsy and temporal lobe epilepsy and hence have an increased risk of comorbid psychiatric disorders. 3,4 Despite its high prevalence in epilepsy, depression remains poorly recognised and undertreated by health professionals. 5 In a study to assess the effect of sertraline on seizure frequency in 100 patients with epilepsy and depression, 60 per cent had a one-year history of psychiatric symptoms, but only 35 per cent of these had been offered or requested treatment within six months of symptom onset. 5 Gilliam et al. found that in the majority of patients, depression is missed because clinicians do not enquire about depressive symptoms. 6 The impact of depression needs to be highlighted. Depression and low mood have been shown to be a strong predictor of health-related quality of life. [6][7][8] Even in people with well controlled seizures, depression remains the main determinant of quality of life. 9 A higher suicide rate has also been reported in people with epilepsy compared with their healthy counterparts. Lifetime prevalence of suicidal ideation in individuals with epilepsy was 25 per cent and 13.3 per cent in healthy controls. 3 Furthermore, the presence of psychiatric illness, and more so depression, has been shown to be associated with poor response to antiepileptic treatment. 10 Hitiris et al. followed up 780 patients with new-onset epilepsy over a median period of 79 months. Patients with epilepsy and psychiatric illnesses were less likely to be seizure free than those with epilepsy without depression. 10 Similar results were found in individuals undergoing epilepsy surgery for temporal lobe epilepsy. Those who had a history of depression were less likely to be seizure or aura free compared with those with epilepsy and no psychiatric history. 11,12 These findings highlight the need for increased awareness of this common psychiatric symptom among clinicians .In this article, we discuss the risk factors, pathophysiology and treatment strategies for depression in epilepsy.
What are the risk factors for depression in epilepsy?Several factors including gender, genetics, seizure type, ep...