Treatment issues for psychiatric comorbidities of epilepsy

SUMMARY Although frequently encountered in epilepsy, psychiatric comorbidities are still underdiagnosed and undertreated. This is related to the lack of standardized treatment approaches and the limited knowledge of neurologists on the treatment of psychiatric disorders. More recently, international panels have published consensus documents in order to favor a homogenous approach to the problem. This article discusses treatment issues of major psychiatric comorbidities of epilepsy, namely mood and anxiety disorders and psychoses. Moreover, specific problems in intellectually disabled patients are presented. In general terms, new psychotropic medications, both antidepressant and antipsychotic drugs, are preferred in terms of safety and efficacy. Careful attention to special needs of the patient, to drug–drug interactions and the adoption of individualized titration schedules represent important variables.