Evaluating the Psychiatric Sequelae of Long-Term Anti-Epileptic Medication Use in Adult Epilepsy Patients in Pakistan

Background: Long term anti epileptic drug (AED) therapy is required for epilepsy, a disorder of the nervous system, for which the sequelae might be associated with significant psychiatric problems. However, despite growing international awareness, there are few data from lower and lower-income countries such as Pakistan, where integrated neuropsychiatric screening is rarely practiced. The purpose of this study was to determine the prevalence and predictors of psychiatric morbidity in adult epilepsy patients on prolonged AED treatment. Methods: The study was conducted cross-sectionally at Ghurki Trust Teaching Hospital, Lahore, and Farooq Hospital, Lahore, Pakistan from November 2023 to October 2024 . Forty-five adult patients (≥ 18 years) with a proven diagnosis of epilepsy and on AED therapy for 12 months or more were enrolled. Hospital Anxiety and Depression Scale (HADS) and Mini International Neuropsychiatric Interview (MINI) were used to assess psychiatric symptoms. Demographic, clinical, pharmacologic, and biochemical data (serum B12, folate, and calcium) were recorded and analyzed in SPSS version 27.0 Results: 60% of patients had depression (HADS ≥8) and 48% anxiety. Major depressive disorder was diagnosed in 26%, generalized anxiety disorder in 18%, and psychotic symptoms in 6% by MINI-based diagnoses. A significantly greater psychiatric morbidity was found in patients on polytherapy than in those on monotherapy (p < 0.05). More commonly, polytherapy users had nutritional deficiencies. There was a significant correlation between longer AED duration and higher depression scores (p = 0.031, R² = 0.42). Conclusion: Adult epilepsy patients on long-term AEDs have a high prevalence of psychiatric morbidity, especially those on polytherapy and older agents. Improvement in neuropsychiatric outcomes in epilepsy care requires routine psychiatric screening and optimization of AED regimens.