A systematic review on mental health issues in adults with newly diagnosed epilepsy

Mental health conditions often co-occur with epilepsy, causing burden and stress beyond seizures. Some of these conditions can emerge early and even predate the onset of seizure and/or epilepsy diagnosis. This systematic review synthesizes evidence on mental health outcomes in adults with newly diagnosed epilepsy (NDE).

A systematic literature search was conducted up to September 2025. All quantitative studies were included without restriction to study types. Mental health outcomes included a board range of mood, anxiety, quality of life, and stigma as primary or secondary outcome measures that were assessed and reported using validated scales. Standard methodological procedures for literature search, data collection, assessment of risk of bias, and analysis were used based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guideline.

Twenty-one publications (n = 4728 adults) across 10 countries were included, of which 12 (57%) showed low risk of bias. Methodological heterogeneity precluded meta-analysis. Depressive and anxiety symptoms were the most frequently assessed, with 11%-50% (data from 14 papers) and 25%-35% (11 papers) of NDE screened positive on validated screening tools, respectively. Structured diagnostic tools in two papers revealed clinical depression in 2.9%-13.3% and anxiety/neurotic disorders in approximately one-quarter of NDE. The prevalence of perceived stigma was reported in 25%-53% of NDE; quality of life was impaired by mood symptom, stigma, and role disability.

Mental health conditions impose a substantial early burden among adults with NDE. Managing this burden requires integrating routine screening into early care pathways as a first step, coupled with a tiered psychiatric diagnostic process. Psychoeducation on these mental health risks should also be integrated into epilepsy care to promote awareness and access to services.