A comprehensive systematic review and meta-analysis of 20 psychiatric disorders evaluated their prevalence among persons with epilepsy compared with participants without epilepsy. The analysis, published in JAMA Neurology, included 27 studies comprising 565,443 PWE and 13,434,208 controls, with data from inception to February 2024 across Ovid, MEDLINE, Embase, and PsycINFO databases.

Results demonstrated significantly higher rates of psychiatric comorbidities among persons with epilepsy (PWE). Depression was nearly 2.5 times more common in PWE (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.94-3.09), and anxiety disorders were twice as likely (OR, 2.11; 95% CI, 1.73-2.58). PWE also demonstrated elevated odds of bipolar disorder (OR, 3.12; 95% CI, 2.23-4.36), psychotic disorders (OR, 3.98; 95% CI, 2.57-6.15), and autism spectrum disorder (ASD) (OR, 10.67; 95% CI, 6.35-17.91).

Substance use disorders were significantly more prevalent in PWE (OR, 2.75; 95% CI, 1.61-4.72), including alcohol misuse (OR, 3.64; 95% CI, 2.27-5.83) and alcohol dependence (OR, 4.94; 95% CI, 3.50-6.96). Attention-deficit/hyperactivity disorder was identified in 13% of PWE compared with 3.4% of controls (OR, 3.93; 95% CI, 3.80-4.08), and suicidal ideation was significantly elevated in PWE (OR, 2.25; 95% CI, 1.75-2.88).

The research included 14 studies from Europe, 10 from North America, 2 from Asia and Oceania, and 1 from Latin America, with no studies from African or Eastern Mediterranean regions. The review had no restrictions on language or publication date, and abstracts were reviewed in duplicate.

These findings indicate a high prevalence of psychiatric comorbidities in epilepsy and the associated morbidity. The bidirectional relationship between epilepsy and psychiatric disorders may stem from shared neurobiological, genetic, and psychosocial factors. The study recommends incorporating validated psychiatric screening tools into epilepsy care training curriculum.

Full disclosures can be found in the published study.