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Management of depression in patients with epilepsy
Preictal and ictal depression do not usually require treatment with antidepressants, as an improvement in seizure frequency should reduce the occurrence of these forms of depression (Labert & Robertson, 1999). Antidepressant therapy will be usually necessary in patients suffering from interictal depression or comorbid depressive disorders. SSRIs are recommended as first-line treatment (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). Citalopram and sertraline can be considered first-line SSRIs because of their minimal pharmacokinetic interactions with antiepileptic drugs (Kanner and Nieto, 1999; Barry et al., 2001).
If depression develops, it should be determined whether the patient takes an antiepileptic drug with a known depression-inducing effect, or if treatment with an antiepileptic drug with mood-stabilizing effects was discontinued. In first case, replacement with an antiepileptic drug with mood-stabilizing effects, such as carbamazepine, valproate, lamotrigine, gabapentin or topiramate can be considered. In the latter case, the discontinued agent should be readministered (Labert & Robertson, 1999, Kanner and Nieto, 1999; Kanner and Palac, 2000). In agitated patients who require treatment with sedative preparations, mirtazapine can be considered a treatment option. In general, dosages should be increased carefully and in small increments. Regular EEG recordings are recommended (Prueter and Norra, 2005).
Ref: -
Barry, J.J., Lembke, A. & Hyunh, N. (2001) Affective disorder sin epilepsy. In: Ettinger, A.B. & Kanner, A.M. (Eds.), Psychiatric issues in epilepsy: a practical guide to diagnosis and treatment, Lippincott Williams and Wilkins: Philadelphia. pp 45 - 71.
Kanner, A.M. & Nieto, J.C. (1999) Depressive disorders in epilepsy. Neurology, 53, 5 (suppl 2), s 26 - s32.
Kanner, A.M. & Palac, S. (2000) Depression in epilepsy: a common but often unrecognised comorbid malady. Epilepsy and Behavior, 1, 37-51.
Labert, M.V. & Robertson, M.M. (1999) Depression in epilepsy: etiology, phenomenology, and treatment. Epilepsia, 40 (suppl 10), s21 - 47.
Prueter, C. & Norra, C. (2005) Mood disorders and their treamtnet in patients with epilepsy. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 1, 20-28. Pharmacotherapy for body dysmorphic disorder
After a detailed review of the literature, Allen and Hollander (2000) concludes that SSRIs are the first-line therapy for body dysmorphic disorder, with the dosage and length of trial similar to those used for OCD. In refractory cases, especially if delusional conviction is present, augmentation with low doses of atypical antipsychotics might be effective. Other augmentation strategies that are clinically used include adding bupropion, gabapentin, or stimulants such as dexamphetamine to the SSRI therapy.
Ref: - Allen, A. & Hollander, E. (2000) Body dysmorphic disorder. The Psychiatric Clinics of North America, 23 (3), 617 ? 628. Donating a Chance to Conceive
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