Depression in Epilepsy: Prevalence and Treatment

The prevalence of depression in patients with yet active epilepsy ranges from 20% to 55%, while that in those with controlled epilepsy ranges from 3% to 9%. As compared to the general population of adults, the rate of depression in epilepsy patients is 4- to 5-fold greater. In addition, the prevalence for a depressive-like state in patients with epilepsy has been shown to be higher as compared to healthy control subjects. Suicide attempts as well occur 10 times more frequently in affected patients than the general population, with the risk considered to be particularly high in those with temporal lobe epilepsy, up to 25-fold greater than in the general population. Two important clinical questions must be answered before prescribing antidepressants to a patient with epilepsy. First, a decision must be made regarding prioritization when considering the most appropriate treatment, replacement of an antiepileptic drug with a negative psychotropic property or administration of antidepressant agents. Second, is the antidepressant being considered universally effective for different types of depression seen in epilepsy patients Unfortunately, while these issues are decisively important for clinical practice, there is only insufficient evidence available, thus some expert opinion will be presented as a substitute. Only inconclusive findings have been provided in view of the efficacy of antidepressant drugs for patients with epilepsy, with only 2 randomized controlled trials (RCTs) conducted thus far. Results obtained in one of those failed to confirm differences between placebo and tricyclic antidepressant administrations, and the other failed to provide sufficient descriptions to consider the findings trustworthy. Although safety has been confirmed for some classes of selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) medications over a short term, a slight but definite proconvulsant property has been found in nearly all antidepressants, including tricyclic antidepressants, SSRIs, SNRIs, and noradrenergic and specific serotonergic antidepressants over a long ter. Lamotrigine is also available for patients with epilepsy and depression, with 2 RCTs presented, of which 1 demonstrated efficacy in comparison with a placebo.