Abstract
This review provides a practical, evidence-informed approach to initiating pharmacologic treatment for children and adolescents with epilepsy who present with comorbid neuropsychiatric symptoms including depression, behavioral dyscontrol, and attention-deficit/hyperactivity disorder. The paper addresses how to determine when medication is warranted, outlines considerations for medication selection, and offers general principles for medication initiation and monitoring. Although the discourse is aimed at a pediatric population, the concepts are applicable to other ages as well. The goal is to provide clinicians with a decision-making framework to optimize both neurological and psychiatric outcomes in this complex population.