Depression in older adults with epilepsy: Pathophysiology and management considerations.

Older adults with epilepsy are at an increased risk for comorbid depression, which worsens their quality of life. This review aims to outline the pathophysiological mechanisms thought to underly the comorbidity of depression in older adults with epilepsy and propose clinical and pharmacological considerations for the holistic management of depression in this population. Indeed, there is a wide range of reported prevalence of depression in older adults with epilepsy, yet these are likely underestimates since depression is underdiagnosed in this population. Age-related drivers of depression include biological and social risk factors such as neurodegenerative changes, inflammation, cerebrovascular dysfunction, social isolation, stigma, and poor health status. Additional contributors related to epilepsy include the impact of seizures, the effects of anti-seizure medications, and the role of sleep-disordered breathing. Therefore, the management of depression in older adults with epilepsy is centered on screening for depression and obstructive sleep apnea, careful choice of anti-seizure medications and anti-depressants, and the provision of social and psychological support.