Screening for Anxiety and Depression in Adults With Epilepsy

Key Takeaways:

• Anxiety and depression are among the most common comorbidities in epilepsy and are frequently under-recognized in routine visits.
• The relationship is bidirectional and affects quality of life, adherence, seizure outcomes, and suicide risk, so it is not a problem to defer, making routine screening an important part of epilepsy care rather than something to postpone until symptoms are volunteered.
• Brief validated tools – the NDDI-E and the GAD-7 – make screening feasible within a standard epilepsy visit.

Depression and anxiety are among the most common comorbidities in epilepsy, yet they are frequently missed in visits organized around seizure control. Part of the difficulty is overlap: Low energy, poor concentration, and sleep disruption can be attributed to seizures or to antiseizure medications (ASMs) rather than to a mood or anxiety disorder. Screening tools developed for this population help identify patients who may benefit from further evaluation while accounting for symptoms that overlap with epilepsy and antiseizure medications.

In many patients, depression and anxiety have a greater impact on daily quality of life than seizure frequency alone, making recognition and treatment an important part of comprehensive epilepsy care.

A common, bidirectional comorbidity

The link runs in both directions. Depression and anxiety are more prevalent in people with epilepsy than in the general population. For some patients, these disorders predate the onset of epilepsy, supporting a bidirectional relationship rather than viewing psychiatric symptoms simply as a reaction to the diagnosis.^1,2

The lifetime prevalence of depression in epilepsy has been reported to be as high as 55 percent in some series. The scale of the burden is visible in patient-reported data as well. In the 2026 Epilepsy In America survey, 48 percent of respondents reported a diagnosis of anxiety, around 40 percent a diagnosis of depression, and 33 percent reported high worry about their mental health.^2,3

These are contextual, patient-reported figures rather than clinical prevalence estimates. However, they reinforce what clinicians see in practice and are consistent with the broader literature showing that depression and anxiety are common in epilepsy.

Why screening matters

Untreated mood and anxiety disorders in epilepsy are associated with worse quality of life, reduced treatment adherence, higher healthcare utilization, and greater seizure burden. Suicide risk is also elevated, particularly among patients with comorbid psychiatric illness: Suicidal ideation is roughly 2 to 3 times more prevalent in people with epilepsy than the general-population lifetime rate of about 13 percent, and substantially higher still in those with comorbid mental-health disorders. Importantly, suicidal thoughts and behaviors often predate initiation of antiseizure medications, highlighting that psychiatric symptoms are not simply a medication adverse effect.¹

That timing matters because many people who die by suicide have had contact with a medical provider in the preceding month, which places neurology and primary-care visits in a position to intervene. Because patients will not always raise these symptoms unprompted – whether because of stigma, being unsure about what is related to epilepsy, or because visits naturally focus on seizure control – routine screening, which professional-society statements recommend, is the practical way to detect them early rather than incidentally.¹

Tools that fit the visit

Two brief instruments are well suited to a busy clinic.

Neurological Disorders Depression Inventory for Epilepsy (NDDI-E)

The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a 6-item, epilepsy-specific screen designed to avoid symptoms that overlap with ASM adverse effects – such as trouble concentrating or fatigue – and is brief, validated, freely available, and intended to identify patients who may need further evaluation rather than establish a diagnosis. Its positive-screen cut-off varies across populations and translations, so the threshold should follow the validated version in use.¹

Patient Health Questionnaire (PHQ-9)

Where a more general depression measure is preferred, the 9-item Patient Health Questionnaire (PHQ-9) covers all 9 DSM-5 depression criteria and can serve as an alternative, though it includes somatic items that overlap with epilepsy and its treatment.¹

Generalized Anxiety Disorder 7-item scale (GAD-7)

For anxiety, the Generalized Anxiety Disorder 7-item scale (GAD-7) is validated in epilepsy, with a cut-off of around 6 performing well for detection. A positive screen should prompt further clinical assessment rather than be interpreted as a diagnosis. What happens next depends on symptom severity, functional impairment, and clinician comfort: Milder presentations can often be co-managed in the neurology or primary-care setting, while more severe symptoms, diagnostic uncertainty, or any active suicidality warrant referral to mental health professionals.^1,4

Building one of these tools into the visit, with a defined response when it is positive, helps ensure that depression and anxiety are recognized early and addressed as part of routine epilepsy care rather than being overlooked during seizure-focused visits.