At least one third of patients with active epilepsy suffer from significant impairment of their emotional well-being. A targeted examination for possible depression (irrespective of any social, financial or personal burdens) can identify patients who may benefit from medical attention and therapeutic support. Reliable screening instruments such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) are suitable for the timely identification of patients needing help. Neurologists should be capable of managing mild to moderate comorbid depression but referral to mental health specialists is mandatory in severe and difficult-to-treat depression, or if the patient is acutely suicidal. In terms of the therapeutic approach, it is essential first to optimize seizure control and minimize unwanted antiepileptic drug-related side effects. Psychotherapy for depression in epilepsy (including online self-treatment programs) is underutilized although it has proven effective in ten well-controlled trials. In contrast, the effectiveness of antidepressant drugs for depression in epilepsy is unknown. However, if modern antidepressants are used (e.g. SSRI, SNRI, NaSSA), concerns about an aggravation of seizures and or problematic interactions with antiepileptic drugs seem unwarranted. Epilepsy-related stress ("burden of epilepsy") explains depression in many patients but acute and temporary seizure-related states of depression or suicidality have also been reported. Limbic encephalitits may cause isolated mood alteration without any recognizable psychoetiological background indicating a possible role of neuroinflammation. This review will argue that, overall, a bio-psycho-social model best captures the currently available evidence relating to the etiology and treatment of depression as a comorbidity of epilepsy.

SummaryBackground While rosacea is a chronic skin condition, it can often have a large psychosocial impact on the individual. There is therefore a need to understand the experience of living with rosacea from the patient perspective. Objectives To examine the experience of living with rosacea and the experience of seeking and receiving treatment. Methods Nine participants took part in semistructured interviews, which were analysed using interpretative phenomenological analysis. Results Three superordinate themes were identified within the data: 'self-consciousness', which focused on the fear of others assigning blame to participants for having caused symptoms; 'avoidance, concealment and hiding emotions', referring to the coping strategies participants employed in response to rosacea; and 'inconsistencies in general practitioner treatment and guidance', which focused on the need for medical professionals to assess the psychosocial wellbeing of patients with rosacea. Conclusions Rosacea can have a negative impact on the daily life of people with the condition, contributing to lowered self-esteem, embarrassment and feelings of shame. Engaging in emotion-focused and behavioural/avoidant-focused coping strategies increased participants' confidence and reduced their avoidance of social situations. However, such strategies might still serve to maintain underlying unhelpful cognitive processes. Consequently, it is important for medical professionals to assess for the presence of cognitive factors that might contribute to maintaining distress in patients with rosacea, and where unhelpful thoughts or beliefs are reported, patients may need to be referred for psychological support.

Vitiligo is a chronic and visible skin condition involving depigmentation with half of those with the condition developing it before the age of 20. This study sought to gain an experiential understanding of the impact of vitiligo on children and their parents. Interpretative phenomenological analysis was used, and semi-structured interviews were conducted with four child–parent dyads (eight participants). Analysis of the participants’ accounts revealed four overarching themes (Continuing Burden, The Significance of Visible Difference, Uncertainty and Unpredictability, and Coping), with 12 subthemes. There were some subtle differences between the parents and children. Both parents and child participants described the condition as posing a continuing burden with most participants reporting experiencing unwanted attention and being concerned about future relationship impact. Some parents described experiencing a sense of resignation to the condition, whereas all the children described a greater sense of acceptance. Nevertheless, acceptance seemed fragile, and parents were concerned that their children needed assistance in developing self-confidence. The findings represent the first in-depth analysis of childhood vitiligo.