Epilepsy and mental health: the connection nobody talks about enough

Epilepsy is a neurological condition, but its effects don't stay neatly within the neurological domain. Research consistently shows that people with epilepsy are significantly more likely to experience mental health conditions — particularly depression, anxiety, and ADHD — than the general population. Yet mental health remains a secondary conversation in most epilepsy care settings.

This article is for people with epilepsy who are struggling with their mental health, as well as carers and family members trying to understand why things are so hard — and what the path towards better support looks like.

The statistics

The numbers are striking. Depression affects around 20–30% of people with epilepsy — two to three times the rate in the general population. Anxiety is similarly elevated. ADHD is more common in children with epilepsy. Psychosis is rare but significantly more common than in people without epilepsy.

This isn't a coincidence or simply a response to the difficulties of living with a chronic condition (though that plays a role). The relationship between epilepsy and mental health is bidirectional and neurological — the same brain regions and neurotransmitter systems are often implicated in both.

Why the connection exists

There are several reasons why epilepsy and mental health conditions so often co-occur:

Shared neurobiology

Epilepsy involves dysregulation of brain electrical activity, particularly in areas like the temporal lobe and limbic system — regions that are also central to mood regulation. The same structural or functional differences that create seizure susceptibility can also create vulnerability to depression and anxiety.

Medication effects

Many anti-epileptic drugs (AEDs) have significant psychological side effects. Some are associated with depression, irritability, or anxiety; others can cause cognitive slowing that mimics or worsens depression symptoms. Levetiracetam (Keppra) is particularly associated with mood and behavioural effects in a proportion of patients. If you've noticed mood changes since starting or changing medication, it's worth raising this explicitly.

The psychological burden of the condition

Living with epilepsy means living with unpredictability. You don't know when the next seizure will happen. You may have lost your driving licence. Your employment options may be limited. You may feel embarrassed by seizures in public, or restrict your activities to avoid potential situations. This is a significant psychological burden — and it would be remarkable if it didn't affect mental health.

Post-ictal psychiatric symptoms

The period after a seizure (the post-ictal phase) can involve more than fatigue and confusion. Post-ictal depression — a period of low mood, tearfulness, and hopelessness that can last hours to days after a seizure — is common and often unrecognised. Post-ictal anxiety and, more rarely, post-ictal psychosis can also occur.

Logging your mood after seizures alongside the seizure itself can help identify whether this pattern applies to you — and separate post-ictal mood episodes from more persistent depression or anxiety.

The treatment gap

Despite the clear connection, mental health in epilepsy often goes unaddressed. GP appointments are short, neurology appointments are even shorter and focused on seizure control, and mental health services often aren't familiar with the specific issues that arise in epilepsy.

People with epilepsy sometimes avoid raising mental health symptoms because they fear being dismissed ("that's just your epilepsy"), because they're already on multiple medications and don't want more, or because they've learned to minimise their symptoms.

What to do

If you're struggling with your mental health alongside epilepsy, you deserve support for both — they're not separate issues.

• Raise it at your next appointment — both with your GP and neurologist. Be specific: "Since starting this medication I've felt significantly lower in mood" or "I experience depression for 2-3 days after every seizure."
• Ask for a medication review if you think your AED may be contributing to mood symptoms. Sometimes a different AED is equally effective for seizure control with better psychological tolerability.
• Ask for a referral to a clinical psychologist or mental health team familiar with chronic health conditions — ideally with epilepsy experience.
• Use your seizure log to document post-ictal mood patterns — it's useful clinical information that a neurologist or psychologist can act on.