ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy

Depression represents one of the most frequently encountered comorbidities among adults with epilepsy affecting ۱ in ۴ individuals. During the last few years, the ILAE worked on the development of clinical practice recommendations for the treatment of depression in adults with epilepsy. The working group consisted in members of the Task Force of the ILAE Commission on Psychiatry, ILAE Executive and IBE representatives. The development of these recommendations is based on a systematic review of studies on the treatment of depression in adults with epilepsy, and a formal adaptation process of existing guidelines and recommendations of treatment of depression outside epilepsy using the ADAPTE process.The document focuses on first line drug treatment, inadequate response to first line antidepressant treatment, duration of such treatment and augmentation strategies, within the broader context of electroconvulsive therapy, psychological and other treatments. For mild depressive episodes, psychological interventions are first line treatments and where medication is used, Selective Serotonin Reuptake Inhibitors (SSRIs) are first-choice medications (Level B). SSRIs remain the first choice medications (Level B) for moderate to severe depressive episodes, however, in patients partially or non-responding to first line treatment switching to venlafaxine appears legitimate (Level C). Antidepressant treatment should be maintained for at least ۶ months following remission from a first depressive episode but it should be prolonged to ۹ months in patients with a history of previous episodes and should continue even longer in severe depression or in cases of residual symptomatology until such symptoms have subsided.