To assess psychiatric treatment history among adults presenting with active anxiety and/or depression symptoms at a tertiary care epilepsy clinic via a learning health system model.

Ample studies show that persons with epilepsy (PWE) have high rates of mood and anxiety disorders. Neuropsychiatric symptomatology is associated with worse response to pharmacologic and surgical treatment of epilepsy. Screening tools such as the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalized Anxiety Disorder-7 (GAD-7) have been validated in epilepsy. Anxiety and depression screening at every clinic visit is now a new epilepsy quality measure.

Touchscreen administration of NDDI-E and GAD-7 to epilepsy clinic patients upon arrival for a routine visit over a five-month period.  Positive screens (GAD-7≥10 or NDDI-E>15) triggered additional questions regarding current and prior mental health care.

Among 106 individuals with active anxiety or depression symptoms (mean age 41.8 years, 56.6% women), 41 (36.7%) were not receiving medication or mental health treatment. Prior psychiatric hospitalization was reported by 30 (28.3%), and only 50% of those were still under mental health care. Of the study population, 48.1% had active symptoms in spite of current treatment with an SSRI, SNRI, or buspirone. Mean NDDI-E and GAD-7 scores of patients receiving medication treatment (17.2&13.6) were similar to those who were not (16.5&12.3), suggesting undertreatment. Of 28 patients positive for anxiety alone, only 14.3% were under mental health care (compared to 34% for the entire study population).  Notably, 67.9% of anxiety-only patients were women; thus, low treatment rates may reflect or contribute to gender health disparity.

This epilepsy clinic population has a startlingly high level of psychiatric acuity.  This reinforces the importance of addressing and monitoring the psychiatric needs of epilepsy patients, in particular among those on psychotropic medications, many of whom appear to be undertreated.