Epilepsy, anxiety, and depression are all common disorders. It is therefore not surprising that the conditions coexist in a significant number of patients. Indeed, some authors estimate the lifetime prevalence of depression in association with epilepsy to be as high as 55%. Despite this there has been remarkably little research into the mechanism of depression and anxiety in epilepsy, and even less of its treatment. Most epilepsy clinics are overloaded with referrals and the consultation naturally tends to focus on the patient’s seizures and treatment thereof; but it is vitally important that doctors treating people with epilepsy are able to recognise the symptoms of anxiety and, in particular, those of depression. Depression lowers quality of life significantly yet it is an eminently treatable condition. Depression can directly increase seizure frequency through the mechanism of sleep deprivation; failure to recognise depression or inadequate treatment can lead to suicide. Depression also often worsens concordance with antiepileptic medication. Doctors in epilepsy clinics often fail to diagnose depression in their patients and, even when they do, many remain inadequately treated. In primary care, many general practitioners (GPs) are reluctant to give antidepressants to people with depression and epilepsy, fearing that they may exacerbate seizures. As will be seen from the discussion below, this fear is largely unjustified. The mental health of people with epilepsy is often ignored. If this article does nothing else it should encourage readers to examine their practice and ask if they address this important aspect of epilepsy care.

DEPRESSION

Depression in epilepsy may be linked temporally to seizures, but the most common disorder is that of inter-ictal depression. In addition to the recognised symptoms of anhedonia (lack of enjoyment), reduced appetite, poor energy, and sleep disturbance, inter-ictal depression or dysphoria is more likely to be associated with agitation and psychotic features …