Over the last decade, our understanding of the risks associated with use of antiepileptic drugs (AEDs) during pregnancy has greatly expanded. Thanks in large part to the work of international epilepsy pregnancy registries, providers can now give informed counsel to women about the likelihood of major congenital malformations associated with first-trimester exposure to commonly utilized AED as well as on expectations for maternal seizure control during pregnancy. However, managing epilepsy well across all stages of life requires a focus that expands beyond just treatment of seizures. Psychiatric comorbidities of epilepsy are critical determinants of quality of life in epilepsy. One in 5 people with epilepsy have depression and anxiety, and the rate is significantly higher among people with medically refractory seizures.1 Suicide rates are 3 times higher in people with epilepsy than in the general population.2 Despite the recognized prevalence of mood disorders and anxiety in people with epilepsy, these conditions continue to be generally underdiagnosed and undertreated. One often cited barrier to treatment is physician’s fear that antidepressant medications may contribute to poor seizure control. For women with childbearing potential, there may be additional concern that psychotropic medication use could further increase the risk of adverse pregnancy outcomes. In fact, women with epilepsy (WWE) have been shown to be less likely to take antidepressant medication during pregnancy than other women, including women with other chronic diseases.3