Beyond Seizures: Depression in Women with Epilepsy

Background: Women with epilepsy are at increased risk of depression compared with the general population because of hormonal, epilepsy-related, treatment-related, and psychosocial factors. Depression adversely affects quality of life, treatment adherence, seizure control, and reproductive health outcomes. Despite its clinical significance, depression in women with epilepsy remains underdiagnosed and underrecognized. Objectives: To estimate the prevalence of depression in women with epilepsy of reproductive age and to identify associated demographic, clinical, epilepsy-related, and treatment-related risk factors. Methods: This hospital-based, cross-sectional study included 309 women with epilepsy in the reproductive age group (18–49 years) attending our center. Demographic details, epilepsy characteristics, seizure control, and antiseizure medication profile were recorded. Depression screening was performed using the Patient Health Questionnaire-9 (PHQ-9). Comparative statistical analysis and multivariable logistic regression were planned to identify independent predictors of depression. Results: Among 309 women, 102 screened positive on PHQ-9, yielding a prevalence of 33.0%. PHQ-9 positivity was observed in 36% of women with focal epilepsy, and 32.3% with generalized epilepsy. Depression was more common among patients with ongoing seizures compared with those seizure-free for more than 1 year (42.1% vs. 26.8%). Patients with higher seizure frequency (> 1 seizure/month) had greater PHQ-9 positivity compared with those with lower seizure frequency (< 1 seizure/month) (56.3% vs. 34.9%). Depression was also more frequent among patients receiving polytherapy compared with those on monotherapy or off medication combined (39.2% vs. 27.3%). Lower PHQ-9 positivity was observed among women in sustained long-term remission, with 17.1% positivity among those seizure-free for more than 5 years. Conclusion: Depression is common among women with epilepsy in the reproductive age group. Women with ongoing seizures, higher seizure frequency, and polytherapy appear to have a greater likelihood of depression, whereas women in sustained long-term remission had lower PHQ-9 positivity. Routine screening for depression in this population is important. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India