Twenty-eight epileptic children aged six to 16 years were assessed for psychopathology in relation to anticonvulsant monotherapy at the Western Psychiatric Institute and Clinic, Children's Hospital of Pittsburgh and Mercy Hospital, Pittsburgh, PA. Eight patients were treated with phenobarbital, 17 carbamazepine, and three had been withdrawn from their anticonvulsant regimen. The phenobarbital treated group showed a higher rate of major depression than did those treated with carbamazepine or no anticonvulsant (38% vs 0%). The frequency of suicide attempts was similar between groups (13% vs 12%). The phenobarbital treated group had higher scores on the Children's Depression Inventory than did the carbamazepine treated patients. The patients who discontinued phenobarbital therapy recovered from major depressive disorder whereas those who continued the treatment remained depressed. 
COMMENT. Despite the relative safety of phenobarbital compared to other anticonvulsants, the increasing number of reports regarding adverse effects on behavior and cognition preclude its use in children whenever possible. Patients should be monitored closely for symptoms of an affective disorder and intellectual deterioration, and if signs of depression or regression are detected, a change to an alternative anti-convulsant should be considered. (See PNB January 1990; 4:2).