According to an analysis of multiple studies, 23% of people with epilepsy have been diagnosed with depression, 20% with anxiety disorders, and 6% with psychosis and related disorders – all at much higher rates compared to people without epilepsy from the general population.
The reason for this link between epilepsy and mental illness is not entirely clear. Some studies have identified structural and functional changes in the brain in depression and schizophrenia which overlap with those seen in some types of epilepsy. For example, auditory and visual hallucinations are observed in both epilepsy and schizophrenia, although they are usually more complex in the latter (e.g. ringing sounds vs clear voices or geometric images versus images of people). Another factor could be the impact that epilepsy has on a person’s life and independence, and how these psychosocial implications affect their mental wellbeing.
“Those whose seizures are effectively controlled by anti-seizure medications, which happens in 70% of people, may experience the unexplained fear of coping with a life without seizures. And in addition, some anti-seizure medication and surgical treatments can also have psychiatric side-effects.” Says Dr Symon Kariuki, an MQ Mental Health Research Fellow at the KEMRI-Wellcome Trust Research Centre in Kenya.
Whatever the cause, a person’s struggle to maintain their mental health can have a huge impact on their lives, on top of their existing challenges with epilepsy. The compounding effects of stigma from both epilepsy (e.g. fear of unpredictability of seizures) and mental illness (self-blame for mental instability), complicates health seeking behaviour, adherence to treatment and may increase social isolation.
A core part of the Epilepsy Research Institute’s work is to better understand ‘co-morbidities’ – health conditions that affect people in addition to their epilepsy. With clinical and psychosocial complications observed in people with epilepsy also having a diagnosed mental illness, it’s vital we find better ways to help people improve their quality of life and wellbeing.
“Research is essential to developing real-world solutions that support people living with mental health challenges and epilepsy. By advancing research, we can deepen our understanding of why individuals with epilepsy face increased mental health difficulties and identify effective treatments, tools and supports that improve wellbeing and quality of life.” Says Dr Sophie Bennett, an Epilepsy Research Institute Endeavour Project Grant Lead at UCL Great Ormond Street Institute of Child Health.
Edwina, a member of the Epilepsy Research Institute’s Shape Network and Mortality, Morbidity and Risk theme Task Force group, has personal lived experience of this. We asked her to share what it’s like to live with epilepsy on top of mental health issues.
“I faced a relentless, internal battle every day. Questions plagued my mind: Would I fall today? Would I injure myself? Would I even regain consciousness after the next seizure? Beyond the immediate physical risks, I was haunted by the fear of how others perceived me.”
You can read her full story here
Mental illness can be treated using ‘talking therapies’ like cognitive behavioural therapy, or medication such as anti-depressants or anti-psychotics for more severe illness. We have no reason to believe these treatments are not effective for people with epilepsy – but treatment does need to be tailored with both conditions in mind.
One important consideration is drug interaction; for example, some anti-seizure medications can reduce the effectiveness of anti-depressants. Evidence also suggests that people with mental illness have poorer seizure control and are more likely to have epilepsy that is drug-resistant – which complicates treatment further.
“Some anti-depressants also increase the risk of experiencing more seizures despite adherence to anti-seizure medications and earlier seizure control. There are concerns about the risk of suicide following some anti-seizure medications, but the few studies available do not adequately account for reasons for initiation of treatment and how suicidality was measured or monitored.” Says Dr Kariuki.
However, Epilepsy Research Institute-funded research could show how beneficial it could be to find the right treatments for mental illness and epilepsy – particularly in children.
As with adults, mental health difficulties are more common in children with epilepsy, compared to those without. Yet treating mental health problems in these children could help to improve their quality of life, their performance at school, and maybe their epilepsy symptoms.
The Epilepsy Research Institute awarded funding to Dr Sophie Bennett to investigate this further. Her research focused on the impact that mental health treatments can have on children and their families. It was found that caregivers’ mental health improved after their child with epilepsy received mental health treatment, highlighting the importance of providing support for both epilepsy and mental health related problems in children and their caregivers in clinical settings. On the Research Blog this month, Dr Bennett shared more about her results and explain how her work could improve support for children and their families.
“Children who experience both epilepsy and mental health difficulties may face additional challenges that put them at greater risk of lower educational attainment than those without these difficulties. Children and families living with both conditions are therefore likely to be doubly disadvantaged. That’s why we investigated how best to support this vulnerable group of children with epilepsy and their families.” says Dr Bennett.
Evidence emerging from low- and middle-income countries such as Kenya, has confirmed elevated incident of mental health in not only epilepsy but acute symptomatic seizures, underlining similar observations from high income countries. Studies, including from Dr Kariuki and his team, have not delineated whether the mental health comorbidity is contributed by epilepsy or seizure factors, genetic susceptibility and underlying neurological damage, which is common in Africa. Recent findings from Kenya suggest the need to monitor anti-seizure medications in relation to occurrence of psychiatric comorbidities, including suicidal behaviour and systematically assess adverse drug reactions.
Despite the prevalence, there hasn’t been a lot of research into the overlap between epilepsy and mental illness, and as a result, there are plenty of gaps in our knowledge. This is complicated by the shared symptoms between epilepsy and mental health problems, their bidirectional relationship, whereby each condition can precede the other and by the multiple nature of underlying risk factors for the overlap, including genetic susceptibility.
For a start, we need to find the best ways to treat the individual conditions that do not exacerbate the other, or render the treatments ineffective. This will require carefully defined randomised clinical trials, with close monitoring of drug levels and response to treatment, and long-term pharmacovigilance of adverse drug reactions. It’s possible that treatments could be found which work in synergy to tackle both conditions together.
Medical guidelines do make it clear that mental healthcare should be integrated into epilepsy treatment, as envisaged in the WHO’s Intersectoral Global Action Plan (IGAP) on Epilepsy and other neurological disorders. To improve this, we need better integration of research too, to bring scientists and clinicians from the fields of mental health and epilepsy together.
This is one of the motivations for an upcoming Mortality, Morbidity and Risk theme workshop that is planned for Spring 2026. The workshop, called “Breaking the Silence: Mental Health in Epilepsy Care and Research”, will explore mental health and suicide in epilepsy. We welcome anyone with an interest in mental health and epilepsy to join us for this important discussion.
Hundreds of thousands of people in the UK, have to face both epilepsy and mental illness. It’s high time to bring the two research fields together, to find ways to better support them and their families. Only then can we make sure everyone with epilepsy can live and thrive.
This feature has been produced in partnership with MQ Mental Health Research to highlight the important overlap between epilepsy and mental health. Together, we are committed to raising awareness and deepening understanding of how these conditions interact. In Spring 2026, MQ Open Mind will host a podcast on epilepsy and mental health to share advances in research across the field. We look forward to future opportunities to work together.
