Depression and anxiety in adults with epilepsy. Systematic literature review and meta-analysis

People with epilepsy (PWE) are at increased risk of psychiatric comorbidities, particularly depression and anxiety. These conditions adversely affect adherence, quality of life, and seizure control, yet reported frequencies and correlates vary widely. We aimed to estimate the occurrence of depressive and anxiety symptoms in PWE and summarize associated demographic and clinical variables. We searched five databases for studies published between 2018 and 2024. Observational studies assessing symptoms or diagnoses of depression and/or anxiety in adults with epilepsy using validated instruments were included. Study selection, data extraction, and quality appraisal (JBI) were performed independently by multiple reviewers. Random-effects meta-analyses (REML) were conducted using cross-sectional, screening-based proportions. Fifty-four studies were included for data extraction; 49 reported depression outcomes and 33 anxiety outcomes (some reported both). Meta-analysis included 12 cross-sectional studies of depressive symptoms ( n = 3866; 1358 screen-positive) and 14 cross-sectional studies of anxiety symptoms ( n = 4321; 1515 screen-positive). The pooled proportion was 40% for depression (95% CI: 30–50%; I 2 = 97.54%; Q = 427.70, p < 0.001) and 36% for anxiety (95% CI: 28–44%; I 2 = 96.64%; Q = 250.60, p < 0.001). Both outcomes were frequently associated with female sex, polytherapy, temporal lobe epilepsy, and higher seizure frequency; drug-resistant epilepsy and poor seizure control were also commonly reported. Depressive and anxiety symptoms are frequent in PWE, supporting systematic screening and integrated mental health care within epilepsy management. • Systematic review of 54 studies on depression and anxiety in adults with epilepsy • Meta-analysis pooled proportions: 40% depressive symptoms and 36% anxiety symptoms • Female sex, polytherapy, temporal lobe epilepsy, and higher seizure frequency were common correlates. • Drug-resistant epilepsy and poor seizure control were also frequently linked to symptoms. • Findings support routine screening and integrated mental health care in epilepsy management.