The goals of this study were to compare symptoms of anxiety and depression between patients with epilepsy and a healthy control group, and to determine the possible factors associated with clinically significant anxiety and depression symptoms in patients with epilepsy. One hundred and four adult Nigerians (52 with epilepsy and 52 matched healthy controls) were assessed with the Hospital Anxiety and Depression Scale (HADS). The results obtained indicated a statistically significant difference in anxiety and depression symptoms between patients with epilepsy and controls. The association between anxiety symptoms and polytherapy was significant (P=0.008), as was the association between depression symptoms and duration of epilepsy longer than 10 years (P=0.04). Emotional problems are more common in patients with epilepsy than in the general population. Identifying and monitoring those with epilepsy of long duration and rational prescription of antiepileptic drugs are important in reducing the risk of affective problems.