Neuropsychiatric Manifestations in Neurological Diseases

Abstract

Depression is prevalent in people living with epilepsy (PLWE) due to a reciprocal relationship between both conditions. Various depressive disorders can occur in PLWE, often linked to hyperactivity of the hypothalamic-pituitary-adrenal axis, neuroinflammation, and serotonin transmission disruptions, among other factors. Antiseizure medications with adverse psychotropic effects can also cause or exacerbate depression. Depressive symptoms in PLWE are classified into interictal and peri-ictal types. The peri-ictal classes are further subdivided into preictal, ictal, and postictal categories. The dysphoric mood is the most common preictal symptom. Ictal symptoms are usually short-lived, and postictal symptoms may not occur immediately. Depression profoundly impacts PLWE, increasing suicidality, stigma, pharmacoresistance to antiseizure medications, and unfavorable epilepsy surgery outcomes. It notably deteriorates their quality of life even more than the level of seizure control. Therefore, early depression detection is crucial, though the hectic epilepsy clinical environments pose challenges. Efficient use of brief time-taking screening tools can help overcome busy clinical environments. Treatment primarily involves antidepressants, especially selective serotonin reuptake inhibitors, due to their lower seizure risk and favorable side effects. Cognitive-behavioral therapy alongside antidepressants can also be beneficial. When choosing antiseizure medications for PLWE who have depression or are prone to depression, those with positive psychotropic effects should be considered primarily. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2024.