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There is a substantially elevated prevalence of psychiatric disorders in epilepsy. The more than fourfold risk of a psychiatric disorder among people with epilepsy indicated by an analysis of two decades of Danish national health statistics provides an estimate of the substantial size of this effect (Christensen et al. 2007). Among psychiatric comorbidities in epilepsy, depression is the most common, with reported estimates of prevalence commonly in the range of 20%–50%. Depression is a stronger determinant of quality of life than seizure control, but despite its clinical importance it is underdiagnosed and undertreated. Depression in epilepsy is related to stressors such as disability, memory problems, being denied a driver's license, stigmatization, and perceived loss of control. Biological effects are also likely involved, as indicated by a substantial body of preclinical and clinical evidence for altered serotonergic transmission in epilepsy (Alper et al. 2007).

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