| Summary: | Depression is one of the most frequent comorbidities in patients with epilepsy affecting 1 in 4 patients, and this is due to psychological and neurobiological reasons. This is a narrative review of the epidemiological, neurobiological, and clinical aspects of depression in epilepsy. References have been identified through Medline/PubMed searches till February 2019 using the terms “epilepsy” AND “depression”. Additional articles were identified from the author's own files and from chosen bibliographies. Epilepsy and depression have a complex bidirectional relationship suggesting shared neurobiological mechanisms and the possibility that depression is a premorbid symptom of some epilepsy syndromes. The phenomenology of depression can be different from that seen outside epilepsy, but epilepsy-specific screening instruments, such as the Neurological Disorders Depression Inventory for Epilepsy, are now available to be used in routine clinical practice. Sertraline and citalopram can be considered first-line treatment in moderate to severe depression while psychological treatments should always be offered to mild to moderate cases.
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