Impact of antiseizure medications burden on patients' emotional states: an investigation of the interaction effects of urban-rural differences.

BACKGROUND

Patients with epilepsy frequently experience comorbid anxiety and depressive symptoms. While polytherapy is known to increase depressive risk in epilepsy, it remains unclear whether social environments modify this association.

OBJECTIVE

To examine the association between antiseizure medication burden and emotional states (anxiety and depression), and to evaluate whether urban-rural residence moderates this relationship.

METHODS

A total of 406 patients with epilepsy were included. Anxiety and depression were assessed using the GAD-7 and C-NDDI-E. Three multiple linear regression models were constructed: Model 1 (ASM count only), Model 2 (adjusted for variables with p < 0.10 in univariate analyses), and Model 3 (fully adjusted). The interaction between residence and the number of ASMs was tested, and simple effects were examined using estimated marginal means. Sensitivity analyses were performed to assess robustness.

RESULTS

The number of ASMs was positively associated with both anxiety and depression scores (both p < 0.001). In the fully adjusted model, a significant interaction was observed between residential setting and the number of ASMs for depression (β = 2.379, p < 0.01), whereas no such interaction was found for anxiety Sensitivity analyses yielded consistent results, with the interaction effect remaining stable across models.

CONCLUSION

The number of ASMs is significantly associated with emotional states in patients with epilepsy, and its impact on depression is moderated by residential setting. Polytherapy confers a more pronounced detrimental effect on depressive symptoms among rural patients.