The Interictal Dysphoric Disorder of Epilepsy: a Still Open Debate

Mood disorders represent a frequently encountered comorbidity in epilepsy, but the issue of phenomenology of depression is still matter of debate, having relevant implications in terms of treatment and prognosis. The interictal dysphoric disorder has been described by pre-modern psychiatry and recently revitalized by behavioral neurology identifying a pleomorphic pattern of symptoms claimed to be typical of patients with epilepsy. The present paper reviews current literature on this subject. A number of variables seem to be implicated in the complex and pleomorphic nature of interictal dysphoric disorder such as the high comorbidity between mood and anxiety, the pathophysiology of epilepsy with peri-ictal behavioral symptoms, and the psychotropic effect of antiepileptic drugs. Further studies identifying specific behavioral endophenotypes may have practical implications in terms of prognosis and tailored treatment strategies.