The risk of psychopathology is greater in persons with epilepsy than it is in the general population. This increased risk is related to a variety of factors including neurobiologic differences associated with epilepsy, medication-related effects, and disease-related psychosocial factors. Choice of appropriate psychoactive therapy must take into consideration effects on seizure threshold and potential interactions with antiepileptic drugs. Identification of psychopathology and effective treatment can reduce unnecessary morbidity in patients already suffering from a chronic disorder.