Treatment of Depression in Adults with Epilepsy
Patient Guideline Summary
Publication Date: October 1, 2020
This patient summary means to discuss key recommendations from the International League Against Epilepsy for treatment of depression in adults with epilepsy. It is limited to adults 18 years of age and older and should not be used as a reference for children.
- Epilepsy is a seizure disorder. One of every three people with epilepsy has a mental health disorder as well, most often depression.
- Patients with depression may feel sad, hopeless, irritable, tired, or suicidal. They may have appetite changes or lose the enjoyment of activities.
- The severity of depressive episodes ranges from mild to severe. Severely ill patients may be suicidal or completely inert.
- This patient summary focuses on the management of adults with both epilepsy and depression.
- A primary alert should be maintained for suicidal thoughts. If suspected, a psychiatrist should be consulted and hospital admittance considered.
- Patients with depression should be followed even after successful treatment for signs of repeat episodes.
There are multiple treatment options — counseling, medical, non-pharmacologic, and alternative. First and subsequent choices are made based on the severity of the depressive episode, risks and side effects of treatment, the response to current and previous treatment, interactions with other medications or health conditions (like epilepsy), and patient preferences.
- Treatment options:
- Psychoeducation or psychotherapies are preferred for mild episodes.
- Selective serotonin reuptake inhibitor (SSRI) antidepressants are for the initial treatment of moderate to severe depressive episodes.
- At least 6 months is recommended for initial treatment.
- When discontinuing, tapering over 1–4 weeks is preferred over abrupt withdrawal.
- There is a risk of overdose in suicidal patients. Note: SSRIs are not associated with seizure worsening.
- If the response is unsatisfactory, options include:
- Switching from an SSRI to venlafaxine or mirtazapine.
- Adding lithium for at least 12 months
- Augmenting antidepressants with quetiapine or aripiprazole.
- Note: Failure of a treatment choice should prompt assessing a patient’s adherence to the prescribed treatment.
- Hypericum (St John's Wort) is a suggested alternative treatment.
- Suggested non-pharmacologic treatment options:
- Electroconvulsive therapy with consultation from an anesthesiologist
- Light therapy for seasonal affective disorder
- Exercise training
- Vagal nerve stimulation
- Repetitive transcranial magnetic stimulation (TMS)
- SSRI: Selective Serotonin Reuptake Inhibitor
- SSRIs: Selective Serotonin Reuptake Inhibitors
- TMS: Transcranial Magnetic Stimulation
Mula M, Brodie MJ, de Toffol B, Guekht A, Hecimovic H, Kanemoto K, Kanner AM, Teixeira AL, Wilson SJ. ILAE clinical practice recommendations for the medical treatment of depression in adults with epilepsy. Epilepsia. 2022 Feb;63(2):316-334. doi:10.1111/epi.17140. Epub 2021 Dec 5. PMID: 34866176.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.