Beyond seizure control

Mental Health & Epilepsy

Epilepsy and mental health are closely connected. Depression, anxiety and other psychiatric difficulties are more common in people with epilepsy than in the general population, and good epilepsy care should look beyond seizure frequency alone.

How common are depression and anxiety?

NICE’s evidence review found that depression and anxiety occur more often in people with epilepsy than in the general population. One systematic review included in that evidence found pooled prevalence estimates of about 22.9% for depressive disorders and 20.2% for anxiety disorders in adults with epilepsy. Rates vary substantially between studies because populations, diagnostic methods, seizure control and other factors differ.

The important point is not a single percentage: depression and anxiety are common enough that NICE recommends clinicians actively look for them during routine epilepsy management.

Why can mental health be affected?

There is no single explanation. The relationship can involve biological, psychological, treatment-related and social factors at the same time.

• Brain networks and underlying cause: the same brain disorder or network disturbance associated with seizures may also affect mood, emotion or behaviour.
• Seizure burden: unpredictable or uncontrolled seizures can create fear, loss of confidence and restrictions in daily life.
• Sleep and fatigue: disrupted sleep, nocturnal seizures and persistent tiredness can affect mood and coping.
• Medication: antiseizure medicines can cause neuropsychiatric side effects in some people, while effective seizure control may improve wellbeing in others.
• Stigma and discrimination: misunderstanding about epilepsy can affect relationships, work, education, independence and self-esteem.
• Loss and uncertainty: driving restrictions, employment changes, injuries and fear of another seizure can have a genuine psychological impact.

Depression is not simply sadness

Depression can involve persistent low mood, loss of interest or pleasure, hopelessness, guilt, sleep or appetite change, slowed thinking, difficulty concentrating and thoughts of death or suicide. In someone with epilepsy, symptoms such as fatigue, poor concentration or sleep disturbance may overlap with seizures or medication effects, which is one reason proper assessment matters.

NICE recommends that people with epilepsy and depression are assessed and treated using established depression guidance rather than having symptoms dismissed because epilepsy is present.

Anxiety can have several forms

Anxiety may be a separate mental health condition, a response to living with unpredictable seizures, or occasionally part of seizure semiology itself. The ILAE 2025 seizure classification recognises affective phenomena such as fear and anxiety as possible focal seizure manifestations.

That distinction matters. A brief, highly stereotyped episode of sudden fear occurring as part of a focal seizure is not the same thing as persistent generalised anxiety, panic disorder or fear of having another seizure. Recurrent symptoms should be assessed in context rather than labelled from one feature alone.

Mental health symptoms can occur around seizures

Psychiatric symptoms may occur before, during or after seizures, although the evidence varies by symptom and timing. Research describes pre-ictal, ictal and postictal psychiatric manifestations, including changes in mood, fear, confusion and, more rarely, psychotic symptoms.

Postictal psychosis is a recognised but uncommon complication, usually occurring after seizures rather than during the seizure itself. New hallucinations, delusions, severe agitation, marked behavioural change or loss of contact with reality after seizures need urgent medical assessment, especially when they are new or escalating.

Psychosis and epilepsy

Psychotic disorders are less common than depression or anxiety but occur more often in people with epilepsy than in people without epilepsy. They can have different relationships to seizures: ictal, postictal, interictal, or treatment-related. This is a specialist area and should not be self-diagnosed from one unusual experience.

Medication and mood

Some antiseizure medicines can affect mood, behaviour, irritability or thinking in some people. The UK MHRA has also warned of a small increased risk of suicidal thoughts and behaviour associated with antiseizure medicines as a drug class.

This does not mean someone should stop epilepsy medication suddenly. Abrupt withdrawal can increase seizure risk and can be dangerous. New mood changes, distressing thoughts or behavioural changes after starting, increasing or switching medicine should be discussed promptly with the prescribing team.

Suicide risk needs to be taken seriously

NICE specifically advises healthcare professionals to be alert to suicide risk in people with epilepsy. A 2023 systematic review and meta-analysis also found higher rates of suicidal thoughts, attempts and suicide in people with epilepsy than in control populations, although individual risk varies greatly.

Risk is not explained by epilepsy alone. Depression, social isolation, substance misuse, uncontrolled seizures, treatment burden and other factors can contribute. Asking about suicidal thoughts does not create them; identifying risk allows support and treatment to begin.

Psychological treatment can still help

Having epilepsy does not make psychological treatment inappropriate. WHO guidance says psychological approaches such as cognitive-behavioural methods, psychoeducation, relaxation-based approaches and family counselling may be considered alongside epilepsy care. NICE recommends using established mental health guidance when depression, anxiety or other conditions are identified.

The right approach depends on the person, the mental health condition, seizure pattern, medication, age and local services. For some people, coordinated care between neurology, primary care, psychology and psychiatry is particularly important.

What should be reviewed routinely?

NICE recommends that routine epilepsy management includes review of mental health, social and emotional wellbeing, cognition and neurodevelopment where relevant. A useful review can include changes in mood, anxiety, sleep, behaviour, concentration, medication effects, social isolation and whether epilepsy is limiting everyday life.

Sources and guidance

NICE NG217 — Psychological, neurobehavioural, cognitive and developmental comorbidities

NICE NG217 — Full guideline, including recommendations 9.2.2 to 9.2.4

NICE Evidence Review 15 — Psychological disorders in epilepsy

World Health Organization — Epilepsy fact sheet

WHO — Psychological interventions in adults and children with epilepsy

Systematic review and meta-analysis — Psychiatric comorbidities in people with epilepsy

Systematic review and meta-analysis — Suicidality and epilepsy

Umbrella review — Peri-ictal psychiatric manifestations in epilepsy

MHRA — Antiepileptics and suicidal thoughts and behaviour

NHS — Urgent mental health support

Medical note: Mental health symptoms deserve assessment in their own right. New severe behavioural change, psychosis, suicidal thoughts or immediate safety concerns need urgent professional help.