Reply to Letter to the Editor "Affective Illness and Epilepsy"

Letter to the Editor

Sir: The remarkable effectiveness of antidepressant and double antidepressant treatment for the intermittent and pleomorphic affective-somatoform disorder of epilepsy (termed the interictal dysphoric disorder) has led to the hypothesis that the proconvulsant antidepressants may be helpfully antagonistic to inhibitory, seizure-suppressing mechanisms. The latter have been assumed to be responsible for the psychiatric changes of epilepsy. Seizure-suppressing mechanisms undoubtedly develop in the course of chronic epilepsy and assert themselves whenever a seizure occurs to bring it to termination, but their nature is little known, and our hypothesis admittedly remains based chiefly on indirect clinical evidence.