Abstract

People with epilepsy (PWE) frequently suffer from comorbid mood and anxiety disorders. Depression is one of the major psychiatric comorbidities having a negative impact on the quality of life in people with epilepsy. A review of the literature indicates that the majority of antidepressant-related seizures have been associated with either ultra-high doses or overdosing and, generally, the risk of antidepressant-associated seizures is low. Correspondingly, there is some evidence indicating that antidepressants of most widely used groups may additionally lower the risk of triggering seizures. Four antidepressants are not recommended for patients with epilepsy, i.e.: amoxapine, bupropion, clomipramine and maprotiline. Clinicians applying first line of depression treatment in patients with epilepsy should consider use of SSRIs or SNRIs, particularly sertraline, citalopram, mirtazapine, reboxetine, paroxetine, fluoxetine, escitalopram, fluvoxamine, venlafaxine, duloxetine. Implementation of anticonvulsive drugs in depressed patients should include valproate, carbamazepine, lamotrigine, gabapentin, pregabalin. The paper reviews the evidence for the clinical use of antidepressants in PWE.

1. Introduction

People with epilepsy (PWE) frequently suffer from comorbid mood disorders. Lifetime prevalence ranges between 11% and 62% [1]. One of the major psychiatric comorbidities having a negative impact on the quality of life in PWE is depression [2]. The relationship between depression and epilepsy may be bidirectional; having depression would increase the risk of epilepsy, and having epilepsy appears to increase the risk of depression [3]. Suicide attempts among depressed PWE are four- to fivefold more frequent than in the general population [4–6]. Depression has also been associated with higher rates of drug resistance in PWE [7]. Considering these issues the successful and safe treatment of depression associated with epilepsy is of utmost clinical importance.