The inclusion of psychological manifestations in the International League Against Epilepsy’s (ILAE) conceptual definition of epilepsy may suggest their relevance for diagnostic and therapeutic considerations. ^{Reference Fisher, Acevedo and Arzimanoglou1} Accordingly, both the ILAE and American Academy of Neurology recommend that depression and anxiety screening be performed routinely on all patients with epilepsy. ^{Reference Kerr, Mensah and Besag2,Reference Patel, Baca and Franklin3} However, previous studies have suggested that screening is often not performed and many epilepsy patients with psychiatric comorbidities remain untreated. ^{Reference Ajinkya, Fox and Lekoubou4} This is a significant concern because psychiatric comorbidities are among the most important predictors of quality of life in patients with epilepsy. ^{Reference Boylan, Flint, Labovitz, Jackson, Starner and Devinsky5}

Injar and colleagues report on their experience administering screening instruments for depression and anxiety in their epilepsy group over several years. ^{Reference Injar, Keezer, Lapalme-Remis, Chamelian, Bou Assi and Nguyen6} Expectedly, a little more than one-third of patients screened positive on at least one questionnaire. However, fewer than half of these patients received an intervention. Most were referred to a mental health professional, but only two patients were prescribed a new antidepressant medication. Twenty-nine percent had their anti-seizure medication adjusted, which included the introduction of a new anti-seizure medication in 41% of cases. For example, several patients had lamotrigine added, although this is not the first-line treatment for depression or anxiety.

These findings suggest that although the implementation of screening instruments may help identify patients with depression or anxiety, many epileptologists may feel uncomfortable or unsure about how to treat these conditions. As a field, we must do better – not only to increase awareness and diagnosis of psychiatric comorbidities in epilepsy but also to improve education on their management.