Elevated rates of anxiety and depression have been linked to epilepsy. However little is known about their incidence or severity in patients presenting with a suspected first seizure. This study measured anxiety and depression symptoms in patients referred to a First Seizure Clinic. METHODS: Patients presenting to the First Seizure Clinic of a large metropolitan hospital were offered enrolment in a prospective longitudinal Quality of Life study. Patients were predominantly referred from the hospital[rsquo]s Accident and Emergency Department. A self-administered baseline questionnaire, including the Hospital Anxiety and Depression Scale (HADS), was completed prior to the consultation. Patients were seen by an epileptologist who diagnosed the event as a seizure or a non-seizure according to the International League Against Epilepsy classification. RESULTS: Eighty-four patients completed the baseline questionnaire. Sixty-one percent were subsequently diagnosed as having had a seizure and 39% were diagnosed as having had a probable non-epileptic event, 46% of which were syncopal. Anxiety scores at HADS case level (11-21) were measured in 30% of non-seizure patients and 29% of seizure patients. Depression scores at HADS case level (11-21) were measured in 27% of non-seizure patients and 14% of seizure patients. The scores did not differ significantly between the seizure and the non-seizure groups for anxiety (p=0.763) or depression (p=0.065). CONCLUSIONS: The data indicates high levels of depression and anxiety in patients referred to a First Seizure Clinic, regardless of whether they are subsequently confirmed to have had a seizure. This has important implications for the psychosocial management of this patient group.