Treating anxiety and depression in people with epilepsy

The major barriers to detecting, diagnosing and treating depression in the epilepsy clinic are a lack of confidence and a lack of time. Patients with epilepsy have a significantly increased risk of anxiety and depression, and an increased risk of suicide, so conversations about mood should be considered as routine as conversations about SUDEP (sudden unexpected death in epilepsy). Neurologists should feel confident in prescribing serotonin reuptake inhibitors and should know how to refer to local next-stage mental health services if required. Access to psychological well-being services is better than most people are aware of, and self-referral is possible. We would encourage neurologists to strongly consider mental health when prescribing antiseizure medications, especially levetiracetam, and to disseminate such considerations to acute medical, anaesthetic and neurosurgical colleagues. We provide some simple, practical advice to equip neurologists and epilepsy nurses to talk to patients about their mental health and to take initial steps towards treatment.