Impact of Depressive Symptoms on Antiepileptic Drug Adherence Among Epilepsy Patients

  • Authors

    • Faisal Wali Ahmed Department of Internal Medicine, King Saud Medical City, Riyadh, Saudi Arabia
    • Areej Tasawar Department of Medicine, Islamabad Medical and Dental College, Islamabad, Pakistan
    • Sobia Maroof Department of Anaesthesia Benazir Bhutto Shaheed Teaching Hospital, Abbottabad, Pakistan
    • Ayesha Tasawar Department of Medicine, CMH Lahore Medical College, Lahore, Pakistan
    • Warda Mirza Department of Internal Medicine, Capital Medical University, Beijing, China
    • Mehwish Butt Department of Medicine, Sultan Qaboos University, Muscat, Oman
    • Junaid Ayaz Khan Department of Medicine, Sun Yat-sen Medical College, Guangzhou, China
    • Sher Bano Department of Clinical Psychology, Shifa tameer-e- Millat university, Islamabad, Pakistan
    • Rida Shehzad Department of Internal Medicine, Karachi Metropolitan University, Karachi, Pakistan
    https://doi.org/10.14419/7meyhn92

    Received date: May 25, 2025

    Accepted date: June 19, 2025

    Published date: July 2, 2025

  • Epilepsy; Depression; Antiepileptic Drugs; Medication Adherence; Quality of Life

  • Abstract

    Background: Epilepsy patients frequently develop depression among psychiatric illnesses because ‎these conditions diminish both their ability to stick to their medication regimen and their life ‎satisfaction. ‎

    Methods: Researchers conducted a cross-sectional study that involved 300 adult epilepsy patients. ‎They utilized three assessment instruments, including the Patient Health Questionnaire-9 (PHQ-9), Morisky Medication Adherence Scale (MMAS-8), and Quality of Life in Epilepsy Inventory (QOLIE-31). Multiple regression and correlation are data analysis methods. Data was collected ‎from September 2024 to March 2025.‎

    Results: In this sample of 300 participants, 188 males comprised 63% of the total, while women ‎made up the remaining 37%, with 112 participants. Most patients presented with moderate to ‎severe depressive symptoms, which strongly affected their medication adherence levels while also ‎producing negative impacts on their quality of life. A total of 69 people (23%) claimed they did not ‎experience seizures during the past 6 months, whereas 111 participants (37%) stated they had ‎encountered one seizure, and another 95 (32%) responded they had multiple monthly seizures. The ‎analysis through regression revealed depressive symptoms as the strongest predictor for ‎substandard use of AED medications (β = .754, p < .01). ‎

    Conclusion: The presence of depressive symptoms acts as a key obstacle for proper AED use ‎while producing substantial negative effects on epilepsy patients' quality of life. Professional ‎psychological testing and combined mental health treatments should be conducted regularly to help ‎achieve better outcomes in clinical care‎.

  • References

    1. Beghi, E. (2019). The Epidemiology of Epilepsy. Neuroepidemiology, 54(2), 185–191. https://doi.org/10.1159/000503831.
    2. Thijs, R. D., Surges, R., O’Brien, T. J., & Sander, J. W. (2019). Epilepsy in adults. The Lancet, 393(10172), 689–701. https://doi.org/10.1016/S0140-6736(18)32596-0.
    3. Engel, J. (1995). Concepts of Epilepsy. Epilepsia, 36(s1), 23–29. https://doi.org/10.1111/j.1528-1157.1995.tb01648.x.
    4. Banerjee, P. N., Filippi, D., & Allen Hauser, W. (2009). The descriptive epidemiology of epilepsy—A review. Epilepsy Research, 85(1), 31–45. https://doi.org/10.1016/j.eplepsyres.2009.03.003.
    5. Duncan, J. S., Sander, J. W., Sisodiya, S. M., & Walker, M. C. (2006). Adult epilepsy. The Lancet, 367(9516), 1087–1100. https://doi.org/10.1016/S0140-6736(06)68477-8.
    6. Kanner, A. M., & Balabanov, A. (2002). Depression and epilepsy: How closely related are they? Neurology, 58(Issue 8, Supplement 5), S27–S39. https://doi.org/10.1212/WNL.58.8_suppl_5.S27.
    7. Fiest, K. M., Dykeman, J., Patten, S. B., Wiebe, S., Kaplan, G. G., Maxwell, C. J., Bulloch, A. G. M., & Jette, N. (2012). Depression in epilepsy: A sys-tematic review and meta-analysis. Neurology, 80(6), 590–599. https://doi.org/10.1212/WNL.0b013e31827b1ae0.
    8. Hoppe, C., & Elger, C. E. (2011). Depression in epilepsy: a critical review from a clinical perspective. Nature Reviews Neurology, 7(8), 462–472. https://doi.org/10.1038/nrneurol.2011.104.
    9. Lambert, M. V., & Robertson, M. M. (1999). Depression in Epilepsy: Etiology, Phenomenology, and Treatment. Epilepsia, 40(s10), s21–s47. https://doi.org/10.1111/j.1528-1157.1999.tb00884.x.
    10. O’ Rourke, G., & O’ Brien, J. J. (2017). Identifying the barriers to antiepileptic drug adherence among adults with epilepsy. Seizure, 45, 160–168. https://doi.org/10.1016/j.seizure.2016.12.006.
    11. Faught, E. (2012). Adherence to antiepilepsy drug therapy. Epilepsy & Behavior, 25(3), 297–302. https://doi.org/10.1016/j.yebeh.2012.08.027.
    12. Garnett, W. R. (2000). Antiepileptic Drug Treatment: Outcomes and Adherence. Pharmacotherapy, 20(8 Part 2), 191S199S. https://doi.org/10.1592/phco.20.12.191S.35250.
    13. Ettinger, A. B., Good, M. B., Manjunath, R., Edward Faught, R., & Bancroft, T. (2014). The relationship of depression to antiepileptic drug adherence and quality of life in epilepsy. Epilepsy & Behavior, 36, 138–143. https://doi.org/10.1016/j.yebeh.2014.05.011.
    14. Morisky, D. E., Ang, A., Krousel-Wood, M., & Ward, H. J. (2008). Predictive Validity of a Medication Adherence Measure in an Outpatient Set-ting. The Journal of Clinical Hypertension, 10(5), 348–354. https://doi.org/10.1111/j.1751-7176.2008.07572.x.
    15. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
    16. Cramer, J. A., Perrine, K., Devinsky, O., Bryant-Comstock, L., Meador, K., & Hermann, B. (1998). Development and Cross-Cultural Translations of a 31-Item Quality of Life in Epilepsy Inventory. Epilepsia, 39(1), 81–88. https://doi.org/10.1111/j.1528-1157.1998.tb01278.x.
    17. Guo, Y., Ding, X.-Y., Lu, R.-Y., Shen, C.-H., Ding, Y., Wang, S., Tang, Y.-L., & Ding, M.-P. (2015). Depression and anxiety are associated with re-duced antiepileptic drug adherence in Chinese patients. Epilepsy & Behavior, 50, 91–95. https://doi.org/10.1016/j.yebeh.2015.06.042.
    18. Siarava, E., Hyphantis, T., Katsanos, A. H., Pelidou, S.-H., Kyritsis, A. P., & Markoula, S. (2019). Depression and quality of life in patients with epi-lepsy in Northwest Greece. Seizure, 66, 93–98. https://doi.org/10.1016/j.seizure.2019.02.012.
    19. Girgus, J. S., & Yang, K. (2015). Gender and depression. Current Opinion in Psychology, 4(4), 53–60. https://doi.org/10.1016/j.copsyc.2015.01.019.
    20. Chen, S.-L., Lee, W.-L., Liang, T., & Liao, I-Chen. (2014). Factors associated with gender differences in medication adherence: a longitudinal study. Journal of Advanced Nursing, 70(9), 2031–2040. https://doi.org/10.1111/jan.12361.
    21. Mercier, C., Peladeau, N., & Tempier, R. (1998). Age, gender and quality of life. Community Mental Health Journal, 34(5), 487–500. https://doi.org/10.1023/A:1018790429573.
    22. Mula, M., & Sander, J. W. (2007). Negative Effects of Antiepileptic Drugs on Mood in Patients with Epilepsy. Drug Safety, 30(7), 555–567. https://doi.org/10.2165/00002018-200730070-00001.
    23. George, J., Kulkarni, C., & Sarma, G. R. K. (2015). Antiepileptic Drugs and Quality of Life in Patients with Epilepsy: A Tertiary Care Hospital-Based Study. Value in Health Regional Issues, 6, 1–6. https://doi.org/10.1016/j.vhri.2014.07.009.
    24. Szaflarski, J. P., & Szaflarski, M. (2004). Seizure disorders, depression, and health-related quality of life. Epilepsy & Behavior, 5(1), 50–57. https://doi.org/10.1016/j.yebeh.2003.10.015.
    25. Malek, N., Heath, C. A., & Greene, J. (2016). A review of medication adherence in people with epilepsy. Acta Neurologica Scandinavica, 135(5), 507–515. https://doi.org/10.1111/ane.12703.
    26. Juliét Silveira Hanus, Priscyla Waleska Simões, Graziela Amboni, Luciane Bisognin Ceretta, & Tuon, L. (2015). Associação entre a qualidade de vida e adesão à medicação de indivíduos hipertensos. Acta Paulista de Enfermagem, 28(4), 381–387. https://doi.org/10.1590/1982-0194201500064.
    27. Cramer, J. A., Glassman, M., & Rienzi, V. (2002). The relationship between poor medication compliance and seizures. Epilepsy & Behavior, 3(4), 338–342. https://doi.org/10.1016/S1525-5050(02)00037-9.
    28. Merikangas, K. R., He, J., Rapoport, J., Vitiello, B., & Olfson, M. (2013). Medication Use in US Youth With Mental Disorders. JAMA Pediat-rics, 167(2), 141. https://doi.org/10.1001/jamapediatrics.2013.431.
    29. Sperling, M. R. (2004). The Consequences of Uncontrolled Epilepsy. CNS Spectrums, 9(2), 98–109. https://doi.org/10.1017/S1092852900008464.
    30. Suurmeijer, T. P. B. M., Reuvekamp, M. F., & Aldenkamp, B. P. (2002). Social Functioning, Psychological Functioning, and Quality of Life in Epilep-sy. Epilepsia, 42(9), 1160–1168. https://doi.org/10.1046/j.1528-1157.2001.37000.x.

  • Downloads

  • How to Cite

    Wali Ahmed, F. ., Tasawar, . A. ., Maroof, S. ., Tasawar, A., Mirza, W., Butt, M., Ayaz Khan, J., Bano, S., & Shehzad, R. (2025). Impact of Depressive Symptoms on Antiepileptic Drug Adherence Among Epilepsy Patients. International Journal of Basic and Applied Sciences, 14(2), 563-571. https://doi.org/10.14419/7meyhn92