[Depression and epilepsy].

Abstract

AIMS: To review the literature on the frequency, aetiology, risk factors, diagnosis and treatment of depression in epileptic illness with a view to clarifying certain controversial issues in a clinically relevant subject. METHOD: Work published on this subject over the last three years was analysed and the data combined in order to achieve a scientific approach to the clinical handling of these patients. We analyse papers, especially reviews of literature on the subject, we compare postures and attempt to highlight the most popular. We point out the aspects that are still in need of study and the gaps to be filled in handling protocols, and we propose characteristics required for future research. CONCLUSIONS: Interictal depression is frequent, and appears in some moment in the evolution in one out of every three epileptics, especially in cases of severe epilepsy with frequent seizures. There are aetiological factors and risk indicators, both of a biological and a psychosocial nature, that point to a more likely appearance of depression. Treatment includes the control of epileptic seizures with a reappraisal of the established pharmacological antiepileptic treatment; the use of antidepressants is, however, nearly always necessary. Choice of the antidepressant must be based on knowledge of pharmacological interactions, the side effects, possible effects on the convulsion threshold and efficiency. Among all the antidepressants, the new ones, especially citalopram and some other SSRIs, seem to offer less convulsant risk and maprotiline, amoxapine and bupropion are clearly unadvisable. Electroconvulsive therapy can be a good therapeutic option.