Epilepsy and mental health disorders: current challenges and potential solutions

Epilepsy affects ~50 million people worldwide and is associated with increased psychiatric comorbidities, including depression, anxiety, psychosis and suicidality. Despite this, current epilepsy management primarily focusses on seizure control, potentially overlooking mental health concerns. This article explores the challenges of integrating psychiatric care into epilepsy treatment and proposes solutions for a more holistic approach. Using a consensus development panel method, a multidisciplinary team of neurologists, psychiatrists and a lived-experience expert identified key challenges to optimising the mental health of people living with epilepsy, such as healthcare system fragmentation, underdiagnosis of mental health conditions and inadequate resources. Among the proposed solutions, the need for routine mental health screening, interdisciplinary support and collaboration, and increased research into the neuropsychiatric aspects of epilepsy were highlighted. A shift from a seizure-centric model to a patient-centred approach is advocated, emphasising biopsychosocial care and improved access to psychiatric services. We also discuss prospective practical strategies to tackle the issues identified, including collaborative care models, structured decision trees and AI-driven screening tools, to enhance diagnosis and treatment. Addressing these challenges through systemic change, research investment and service innovation should significantly improve the care and quality of life for individuals with an epilepsy and co-occurring mental health disorders.