The proper treatment of epilepsy requires eliminating seizures as much as possible without incurring intolerable side effects. Furthermore, identifying and treating comorbid conditions, both psychiatric and somatic, has recently emerged as an important priority. In my team’s recent research, we identified somatic and psychiatric comorbid conditions in 50% of women and 43% of men in a population of 6621 people with epilepsy. The top comorbid conditions for women and men with epilepsy were a psychiatric diagnosis, hyperlipidemia, hypertension, asthma, diabetes, headache, and anemia.
A spate of articles emphasizing the importance of epilepsy-related comorbid conditions recently appeared in Epilepsy and Behavior. Asato and colleagues wrote, “Epilepsy increases the likelihood of depression, anxiety disorders, attention deficit hyperactivity disorder (ADHD), a schizophrenia-like interictal psychosis, autism, as well as suicidal behavior in patients with an unprovoked seizure, focal epilepsy, idiopathic cryptogenic epilepsy, and self-reported epilepsy…contemporary standards of practice fail to integrate screening and treatment of the comorbidities into routine care.”
Andres M. Kanner, MD, an epileptologist and psychiatrist at the University of Miami in Florida, observed, “Depression and anxiety disorders are the most frequent psychiatric comorbidities in people with epilepsy (PWE), with lifetime prevalence rates estimated to range between 30%-35%. Yet, despite the wide recognition of the problems associated with these two conditions, they remain undiagnosed and untreated in a vast majority of these patients.”
Dr. Kanner recommended that neurologists should be trained to identify and manage common psychiatric disorders, but acknowledged that these efforts could be compromised by the limited time allowed for patient encounters; the meager psychiatric background of many neurologists; and the traditionally poor communication between neurologists and psychiatrists.
Unfortunately, most neurologists do not have extensive psychiatric training and do not feel confident treating psychiatric disorders. Jones emphasized the importance of “innovative tools that are easily translated into clinical settings in order to begin to address the barriers that contribute to the underidentification of these co-occurring problems.”
New Treatment Tools for Psychiatric Conditions
To address the common problem of psychiatric comorbid conditions, Philip Gattone, MEd, President and Chief Executive Officer of the Epilepsy Foundation, Landover, Maryland, encouraged practitioners to take advantage of 2 new programs offered by the Epilepsy Foundation: PEARLS (Program to Encourage Active Rewarding Lives) and Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts), which are collaborative programs with the Epilepsy Foundation, Centers for Disease Control and Prevention, and the Managing Epilepsy Well (MEW) Network. 
PEARLS consists of eight 50-minute sessions followed by 3-4 follow-up telephone calls designed to treat major depression, minor depression, and dysthymic disorder in adults with epilepsy. Project UPLIFT is also designed for adults with epilepsy. It lasts 8 weeks and can be accessed by phone or Internet.
There is an overwhelming consensus that comorbid conditions negatively affect many people with epilepsy and need to be addressed to improve their quality of life. Psychiatric comorbid conditions in particular, such as depression and anxiety, may often be overlooked. Given the limitations of time, training, and resources, the treatment of psychiatric comorbid conditions in people with epilepsy represents a challenge for neurologists.
Heightened awareness and increased training are required. Clinical tools, such as PEARLS and UPLIFT, are currently available and should be applied when appropriate. To learn more about these resources, contact the Epilepsy Foundation.