"I'm lonely": An underrecognized marker of silent suffering in PWE in underresourced settings?

Loneliness is increasingly recognized as a significant psychosocial determinant of health, yet it remains comparatively underexplored in the context of epilepsy, and particularly in under-resourced environments. Unlike depression or anxiety, loneliness is less specifically sought, nor readily disclosed, despite its profound impact on well-being. This article draws on clinical experience and a small observational audit in Jamaica to highlight loneliness as a distinct and pervasive issue among people with epilepsy (PWE). While loneliness frequently co-occurs with depression, it may exist independently and may precede diagnosable mood disorders. Contributing factors include societal stigma, physician-advised safety restrictions, antiseizure medication side effects, and systemic gaps in epilepsy care, factors often greatly intensified in low-resource settings. By focusing on the lived experience of patients, this article argues that loneliness may silently erode quality of life, autonomy, and treatment adherence, in part also from its seemingly close association with depression. It proposes low-cost, socially focused interventions as potentially transformative and suggests the need for inclusion of loneliness as a modifiable factor in clinical practice and future research. A simple question, "Do you feel lonely?" could facilitate the identification of loneliness in PWE, and particularly in underserved communities and LMICs with high social stigma, may help improve psychosocial outcomes, and epilepsy control.