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Comorbid depressive disorders and suicidal behavior are more likely in patients with epilepsy than in healthy individuals. Likewise, epileptic disorders may be more common in patients with depression. Evidence exists for a close, potentially bi-directional relationship between the two disease states, with common underlying anatomic, pathologic, and functional abnormalities.

Unresolved issues include establishing a direct causal link between depression and epilepsy, determining optimal treatment strategies for patients with depressive disorders in the setting of epilepsy, and whether the pathophysiologic characteristics of this subgroup of patients and their response to treatment may substantially differ from patients with primary depression. Preliminary data with standard antidepres-sant regimens, and psychiatric referral when appropriate, appear to be effective initial interventions. It is unknown at this time whether early treatment of a depressive disorder may lower the risk of developing epileptic seizures (Kanner, 2006). Additional study is required.

Further awareness and research promises to offer an improved quality of living for a substantial number of patients with epilepsy and depression, a segment of the neurological community long neglected.

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