Population-level trends of Psychiatric Medication Co-Prescriptions in Persons with Epilepsy: an EPIC Cosmos Study
Using the Epic Cosmos federated electronic health record network, this study characterizes population-level trends in psychiatric medication co-prescriptions among persons with epilepsy from 2018 to 2025, revealing stable antiseizure medication patterns, higher rates of concurrent psychiatric drug use compared to asthma patients, and distinct age-specific prescribing profiles that establish a framework for monitoring psychiatric comorbidity and drug interactions.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Imagine the human brain as a bustling, high-tech city. Sometimes, the traffic lights in this city glitch, causing sudden, chaotic power outages known as seizures; this is the condition called epilepsy. To keep the lights from flickering, doctors prescribe special "traffic controllers" called antiseizure medications (ASMs). But the city of the brain is complex, and the glitches often come with other problems, like the city feeling constantly gloomy (depression), anxious, or hyperactive. These are the psychiatric comorbidities that often walk hand-in-hand with epilepsy. Because the brain is one interconnected system, treating the seizures doesn't always fix the mood, and treating the mood doesn't always stop the seizures. So, doctors often have to hand out two different toolkits at once: one for the seizures and one for the emotions. The big question is, how do these two toolkits mix? Do they work together smoothly, or do they clash like oil and water? And does this mix change depending on whether the patient is a kid, an adult, or a senior?
This paper is like a massive, city-wide census that took a snapshot of millions of people to answer exactly those questions. Instead of looking at just one hospital or one small town, the researchers used a giant, digital network called "Epic Cosmos" to peek at the medical records of over 300 million patients across more than 2,000 hospital systems. They focused on the years between 2018 and 2025, tracking people with epilepsy and comparing them to a similar group of people with asthma (a different chronic condition) to see if the epilepsy group was getting extra psychiatric help.
Here is what they found in this massive data treasure hunt. First, the landscape of seizure medication is surprisingly stubborn. Even though new, shiny "traffic controllers" have been invented in recent years, doctors haven't switched to them in huge numbers. The old favorites, especially a drug called levetiracetam, are still the kings of the hill, making up about 22% of all seizure prescriptions for people under 64 and a whopping 33% for those over 65. It's as if the city planners decided, "If it ain't broke, don't fix it," and stuck with the reliable tools they know.
Second, and perhaps most importantly, the type of extra help people get depends entirely on their age, not on which seizure drug they are taking.
- For the kids (17 and under): The data shows they are much more likely to get prescriptions for ADHD medications, sleep aids, and antipsychotics compared to kids with asthma. It's like the city is handing out extra "focus boosters" and "calm-down kits" to the younger crowd.
- For the adults and seniors: The focus shifts. As people get older, the prescriptions for ADHD meds drop, but the need for "cognitive enhancers" (drugs to help with memory and thinking) goes up, especially in those over 65. This makes sense, as memory issues often become more common as we age.
- The "Clash" Check: The researchers were worried that certain seizure drugs might force doctors to prescribe specific psychiatric drugs to counteract side effects, or that some drugs might be dangerous to mix. However, the data didn't show a specific "seizure drug + specific mood drug" pattern. Whether a patient was on a sodium-channel blocker or a GABA agent, the mix of psychiatric meds they received was mostly the same. The age of the patient was the only thing that really changed the recipe.
One interesting safety note popped up: doctors seem to be very careful with a specific antidepressant called bupropion. Since this drug is known to lower the threshold for seizures (making them more likely to happen), the study found it was prescribed about half as often to people with epilepsy compared to those with asthma. It's a clear sign that doctors are paying attention to the rules of the road.
In short, this study paints a picture of a medical landscape that is stable but highly age-sensitive. The tools for stopping seizures haven't changed much, but the tools for managing the emotional and mental side of the condition are tailored specifically to the life stage of the patient. By looking at such a huge number of people, the researchers confirmed that while the seizure drugs stay the same, the psychiatric support evolves as the patient grows from a child into an adult and then into a senior citizen. This massive survey gives doctors a better map to understand how these two types of medications are being used together in the real world, helping to ensure that the city's traffic lights and mood stabilizers are working in harmony.
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