Meta-Analysis Reveals Patients With Epilepsy at Increased Risk for Psychiatric Disorders

Author(s):

Key Takeaways

Patients with epilepsy have significantly higher odds of psychiatric disorders, including anxiety, depression, and schizophrenia, compared to those without epilepsy.
The study analyzed data from over 565,000 individuals with epilepsy, highlighting the substantial burden of psychiatric comorbidities in this population.
Integrating psychiatric care into epilepsy management is crucial for improving patient outcomes and quality of life.
Some conditions, like suicide attempts, did not show a statistically significant increase, suggesting a complex relationship between epilepsy and psychiatric disorders.

Findings showed that patients with epilepsy were significantly more likely to experience a range of psychiatric disorders, including depression, anxiety, and substance use disorders, compared with those without the condition.

Churl-Su Kwon, MD, MPH

(Credit: X)

A comprehensive systematic review and meta-analysis recently published in JAMA Neurology reported that the odds of psychiatric comorbidities, ranging from anxiety to schizophrenia, were significantly higher in patients with epilepsy compared with those without the seizure disorder. Findings from this analysis, which reviewed 27 studies and included data from over 565,000 individuals with epilepsy, suggest that patients with epilepsy are at an increased risk of developing various psychiatric disorders.¹

In the meta-analysis, results showed significant associations between epilepsy and various psychiatric disorders. For instance, the odds of developing anxiety (OR, 2.11; 95% CI, 1.73-2.58) and depression (OR, 2.45; 95% CI, 1.94-3.09) were more than twice as high in patients with epilepsy. Bipolar disorder was also significantly more frequent in individuals with epilepsy, with a nearly 3-fold increased risk (OR, 3.12; 95% CI, 2.23-4.36). Suicidal ideation was also prevalent, more than twice as high, in patients with epilepsy (OR, 2.25; 95% CI, 1.75-2.88), and psychotic disorders (OR, 3.98; 95% CI, 2.57-6.15), including schizophrenia (OR, 3.72; 95% CI, 2.44-5.67), were particularly concerning, as reported by the authors.

Conducted by lead author Churl-Su Kwon, MD, MPH, assistant professor of neurological sciences at Columbia University Irving Medical Center, and colleagues, the study sought to summarize the prevalence of 20 common psychiatric disorders among patients with epilepsy in comparison to individuals without epilepsy. A systematic search of databases, including Ovid, MEDLINE, Embase, and PsycINFO, led to the inclusion of studies published between the inception of each database and February 2024. The analysis pooled data from more than 13 million individuals without epilepsy, alongside patients with epilepsy, to calculate the odds ratios for various psychiatric conditions.

The study also examined the prevalence of substance use disorders, with notable increases in alcohol misuse (OR, 3.64; 95% CI, 2.27-5.83) and alcohol dependence (OR, 4.94; 95% CI, 3.50-6.96). Additionally, autism spectrum disorder was reported with high odds ratio in patients with epilepsy (OR, 10.67; 95% CI, 6.35-17.91), which authors noted suggests a particularly high risk for individuals with this comorbidity. Other disorders such as obsessive-compulsive disorder, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder were also significantly more common in patients with epilepsy.

Despite the prevalence of these disorders, certain conditions like suicide attempts did not show a statistically significant increase in individuals with epilepsy, which researchers noted suggests that the relationship between epilepsy and psychiatric conditions may be complex and variable. For example, the odds ratio for suicide attempt was much lower (OR, 3.17; 95% CI, 0.49-20.46), with a broad confidence interval, indicating that further investigation may be needed to clarify this aspect.

The study underscored the importance of identifying and managing psychiatric comorbidities in patients with epilepsy. Given the significant impact these conditions can have on a patient’s quality of life, including exacerbating the challenges faced in managing epilepsy, researchers recommended that healthcare professionals should prioritize screening for psychiatric disorders as part of comprehensive epilepsy care. Authors also noted that effective management of these comorbidities could improve overall well-being and help reduce the morbidity associated with epilepsy.

All told, this large-scale study highlighted the substantial burden of psychiatric disorders in individuals with epilepsy, aligning with findings from previous studies.² These results potentially point to a clear need for heightened awareness and more targeted interventions to address psychiatric comorbidities in this population. By identifying and treating these conditions early, healthcare providers could improve outcomes and quality of life for individuals living with epilepsy. As the study emphasized, integrating psychiatric care into the management of epilepsy may need to be a central aspect of patient care moving forward.

REFERENCES
1. Kwon CS, Rafati A, Ottman R, et al. Psychiatric Comorbidities in Persons With Epilepsy Compared With Persons Without Epilepsy: A Systematic Review and Meta-Analysis. JAMA Neurol. 2025;82(1):72-84. doi:10.1001/jamaneurol.2024.3976
2. Fiest KM, Dykeman J, Patten SB, et al. Depression in epilepsy: a systematic review and meta-analysis. Neurology. 2013;80(6):590-599. doi:10.1212/WNL.0b013e31827b1ae0