Psychiatric Comorbidities in Epilepsy: A Critical Appraisal of Prevalence, Pathophysiology, and Clinical Management: A Narrative Review

Epilepsy is a chronic neurological disorder that not only causes recurrent seizures but is also frequently associated with psychiatric comorbidities, most notably depression and anxiety. These mental health conditions significantly impair quality of life, complicate treatment adherence, and worsen clinical outcomes. Despite their high prevalence, psychiatric symptoms often remain under-recognized and undertreated in epilepsy care. This narrative review aims to explore the prevalence, underlying pathophysiological mechanisms, diagnostic challenges, and current management strategies of psychiatric comorbidities in epilepsy. A comprehensive literature search was conducted across PubMed, Scopus, and Embase for studies published between 2000 and 2024, including clinical trials, meta-analyses, and relevant reviews. Depression and anxiety are the most common psychiatric disorders in epilepsy, followed by psychosis and cognitive impairments, with temporal lobe epilepsy showing a particularly strong association. The pathophysiology involves complex neurobiological interactions, including limbic system dysfunction, neurotransmitter imbalances, and the effects of antiepileptic drugs. Effective management requires a multidisciplinary approach combining pharmacological and nonpharmacological interventions tailored to individual needs. Early screening and integrated care models are essential to optimize outcomes. Addressing psychiatric comorbidities is crucial for holistic epilepsy management and improving long-term prognosis.