Psychiatric and neurological comorbidities are relatively common in epilepsy, affecting 30–50% of patients. Neurologists should be able to treat psychiatric comorbidities in patients with epilepsy and identify patients at risk of adverse events from psychotropic medications, because psychiatric care is not available to all patients. In this Review, Andres Kanner discusses the complex relationship between epilepsy and psychiatric and neurological comorbidities, and provides considerations for selection of antiepileptic and psychotropic drugs in patients with epilepsy.