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This single-center retrospective study explores the incidence of anxiety and depression in epilepsy patients and analyze their correlation with seizure control. A total of 201 epilepsy patients treated at our hospital between February 1, 2022, and February 1, 2024 were included. Based on the Hamilton anxiety rating scale (HAM-A) and self-rating depression scale (SDS) results, patients were divided into an AD group (73 cases) and a NAD group (128 cases). Among the AD group, 45 patients (61.6%) underwent anxiety/depression screening for the first time, highlighting the lack of routine psychological assessment in epilepsy management. Demographic characteristics, epilepsy history, seizure characteristics, medication usage, adherence, seizure control, auxiliary examinations, and psychological interventions were collected. Univariate analysis was performed to screen potential factors, and multivariate logistic regression was subsequently used to identify independent risk factors for anxiety/depression. Patients in the AD group had a younger average age (34.5 ± 12.6 years vs 39.1 ± 11.7 years, P = .047), shorter disease duration (P = .043), higher seizure frequency (P = .034), and poorer seizure control (seizure-free rate 24.7% vs 43.8%, P = .007). Additionally, a higher proportion of patients in this group used 3 or more antiepileptic drugs (17.8% vs 11.7%), and had lower medication adherence (19.2% vs 8.6%, P = .052). Anxiety/depression patients were more likely to receive cognitive behavioral therapy (47.9% vs 32.8%, P = .027), individual psychological counseling (39.7% vs 19.5%, P = .011), and emotional support (43.8% vs 36.7%, P = .039). Multivariate logistic regression analysis suggested that shorter disease duration (OR = 1.82, 95% CI: 1.07-3.11, P = .029), higher seizure frequency (OR = 2.17, 95% CI: 1.12-4.23, P = .021), and low adherence (OR = 2.53, 95% CI: 1.01-6.30, P = .048) were independent risk factors for anxiety/depression. Anxiety and depression are relatively common in epilepsy patients, affecting about 36.3% of them. Emotional disorders are closely related to poor seizure control, lower medication adherence, and complex medication regimens. There is a need to strengthen the assessment and intervention of emotional states in epilepsy patients, especially in those with shorter disease duration and frequent seizures, to promote early identification and management of mental health issues. This can help improve comprehensive treatment outcomes and quality of life.