DAY 1 | Depression Symptoms Increase Disease Burden for Patients with Focal Onset Seizures

Findings from a survey reflecting patient-reported outcomes showed that depression symptoms affect quality of life and increase healthcare resource utilization for individuals diagnosed with focal onset seizures (FOS), who experience a significant but underrecognized mental health burden.

Previous studies have shown that people living with epilepsy have a two- to three-fold increased risk of depression compared to the general population (Fiest KM et al. Neurology 2013; 80:590-99). Although many individuals living with FOS experience depression and anxiety, reflected in high positive screening rates, these issues are often underrecognized and underreported in clinical practice. The results of a cross-sectional survey of 170 individuals with FOS, presented at the 2025 American Epilepsy Society Annual Meeting (AES 2025), in Atlanta, Georgia, reinforced the previous findings, showing that patients with FOS, including those without a clinical diagnosis of depression, struggle with significant mental health issues.

The respondents, recruited via a patient panel or by their physicians at the point of care, completed a 30-minute online survey between July and September 2023 and answered questions about seizure-related and non-seizure-related symptoms, comorbidities, and mental health. The study included U.S.-based individuals aged 18 to 80 years with a formal diagnosis of FOS for at least 1 year, who were experiencing at least one seizure in a typical month. The participants had previous exposure to at least two anti-seizure medications and were being treated with at least one anti-seizure medication for at least 1 month before completing the survey. Patients who experienced seizures secondary to drug or alcohol use, ongoing infection, or certain neoplastic, neurologic, or metabolic disorders were excluded. A majority of the respondents (66.5%) were managed by epileptologists.

The researchers collected the data with the use of validated tools, including the Patient Health Questionnaire-9 (PHQ-9), which assesses depression symptom severity based on the DSM-5 criteria for major depressive disorder, and the Quality of Life in Epilepsy Inventory-10 (QOLIE-10). QOLIE-10 is a 10-item questionnaire that evaluates epilepsy-specific and general quality of life across different domains, such as energy, mood, daily activities, and effects of medication.

Of the 170 respondents with FOS, 40% reported a clinical diagnosis of depression. Three-quarters of the individuals with physician-diagnosed depression reported moderate to severe depression symptoms. The PHQ-9 scores showed that more than half (56%) of the 102 patients who did not have a clinical diagnosis of depression also experienced moderate to severe depression symptoms. 
Overall, half of the respondents exhibited at least eight depression symptoms for several days a week during the past 2 weeks. Depressed mood and anhedonia, which are core depression features that may be independent of the adverse effects of medication, were present in most respondents (approximately 81%). The individuals who reported anhedonia were more likely to experience cognitive issues and social issues than those who did not experience this symptom. Moreover, 42% of the participants reported suicidal ideation or thoughts of self-harm for several days a week.

A separate analysis presented at AES 2025 showed that moderate and severe symptoms of depression can exacerbate disease burden for patients with FOS. The authors conducted multivariable regression analyses to assess the independent relationship of depression symptoms with quality of life (QoL) and healthcare resource utilization, including inpatient visits, emergency department visits, and treatment adherence. Patients with moderate to severe depression symptoms were more likely to have a reduced QoL compared to those with mild symptoms and those with no symptoms of depression. After adjusting for the influence of additional predictive variables, including disease-related and demographic factors, the results showed that individuals with moderate to severe depression symptoms had a QOLIE-10 score that was 12 points lower than the score recorded for patients with no symptoms or mild depression symptoms. Moreover, patients with moderate to severe depression symptoms had, on average, more emergency department visits and inpatient visits compared to patients with no symptoms and to those with mild depression symptoms. Individuals who reported moderate or severe depression symptoms also had lower adherence to treatment regimens compared to those with mild symptoms or no depression symptoms. 

Major organizations, including the American Academy of Neurology, strongly recommend screening for depression in people diagnosed with epilepsy, an approach that is now considered essential in clinical practice. “Beyond the published literature, what we found in our survey is that depressive symptoms are associated with worse outcomes,” lead author Alvin Ong, PharmD, noted during a poster presentation. “We are starting to learn increasingly that there is this bidirectional relationship between epilepsy and depression. [While] there is a shortage of access to psychiatrists, there may be different anti-seizure medications with different profiles that maybe can help with some of [these issues].”