Comorbidity of Epilepsy and Depression: Associated Pathophysiology and Management

Abstract

Epilepsy is a neurological disorder characterized by recurrent unprovoked seizures. Depression may arise as a result of other mental or physical problems or as a side effect of the drugs used to treat such illnesses, or it could be caused by epilepsy-related structural abnormalities. However, physicians are hesitant to prescribe antidepressants to patients with epilepsy due to concerns about decreasing seizure thresholds and the harmful drug interactions between antidepressants and antiepileptic medicines. As a result, the question about the optimal care of epileptic patients who suffer from depression remains unanswered. Despite the complicated link between epilepsy and depression, the co-administration of antidepressants and antiepileptic drugs (AEDs) is safe and beneficial when appropriately managed. A focused evaluation for depression (regardless of social, economic, or personal circumstances) might identify people who benefit from medical care and therapeutic assistance. Vagus nerve stimulation and psychological therapies such as cognitive-behavioral therapy, individual or group psychotherapy, patient support groups, family therapy, and counseling are nonpharmacological therapeutic alternatives. In terms of treatment strategy, it is critical to optimize seizure control and limit antiepileptic medications' adverse effects. Psychotherapy for depression in epilepsy is underused, even though it has been shown to be helpful in well-controlled studies. This review article has discussed some parts of the most common pathophysiologies of depression in patients with epilepsy, highlighted the efficacy of psychotherapy and antidepressant drugs, and explored the optimal care of patients with epilepsy who suffer from depression.

The usefulness of NDDI‐E and QOLIE‐10 scales for the screening of major depressive disorders in patients with epilepsy in video‐EEG units

“…These data are in line with published series on the prevalence of depression in patients with epilepsy. [9][10][11] Remarkably, only 43.7% of patients with NDDI-E score > 13 were on antidepressant medication or psychological treatment. This result suggests that more than half of the patients with a positive screening for major depressive disorder were untreated, similar to data published in other series of patients with a diagnosis of depression.…”

“…5 Psychiatric comorbidities are frequent in patients with epilepsy, with a higher prevalence than in the general population, 6 being determined in up to 30%-50% of patients. [7][8][9][10][11][12] Mood disorders, including major depressive disorder, are particularly prevalent. 9 It is now recognized that the relationship between epilepsy and psychiatric comorbidities is bidirectional and complex.…”

“…9 It is now recognized that the relationship between epilepsy and psychiatric comorbidities is bidirectional and complex. 11,[13][14][15][16] Several studies have postulated that proper management of psychiatric comorbidities leads better control of epilepsy and vice versa. 5,17 Screening for mood disorders in clinical practice can be easily performed using self-administered scales.…”

“…Psychiatric comorbidities are frequent in patients with epilepsy, with a higher prevalence than in the general population, 6 being determined in up to 30%–50% of patients 7–12 . Mood disorders, including major depressive disorder, are particularly prevalent 9 .…”

Comorbid epilepsy and depression—pharmacokinetic and pharmacodynamic drug interactions

“…Possibly, better results may be achieved when a patient is prescribed carbamazepine, gabapentin, lamotrigine, topiramate or valproate. These antiepileptics have been documented to improve mood (Alhashimi et al, 2022;Shamabadi, 2022).…”