Children with epilepsy are at increased risk of behavioral problems and psychiatric disorders compared with the general population and those with other chronic illnesses. Depression and anxiety disorders are the most common and require further attention because they carry the risk of reduced quality of life and have far reaching consequences in later life. The wide range of prevalence quoted in the literature reflects methodologic differences. Risk factors are often multifactorial and include illness severity, coexisting morbidity, and psychosocial factors. Diagnosis remains a challenge, as the presentation is heterogenous and age related. This is complicated by epilepsy issues and associated comorbidity that hamper the use of standardized assessment tools. Multimodal treatment involving psychotherapy and antidepressant therapy currently represents the best approach. The mental health needs of these children are largely unmet; increased awareness and better research are required to determine best practices.