Background Psychiatric comorbidities, and sleep disorders, are prevalent in adults with epilepsy (AWE). Good control of epilepsy can help AWE lead a normal fruitful life and incorporate in daily activities as others. This study aims to assess the frequency, risk factors of depression, and poor sleep quality among patients with epilepsy and examine their relation with epilepsy control. Methods This cross-sectional study was accomplished during the period from January to October 2023 involving 179 AWE. All were exposed to complete history taking: stressing on personal data, evaluation of medication adher‑ ence using the modifed Morisky scale, sleep quality using the Pittsburgh Sleep Quality Index, and depressive symp‑ toms evaluated by the Zagazig Depression Scale. Results Depression was reported in 22.2% of studied patients; while 44.4% had poorer epilepsy control. Poor sleep quality was reported in 35.2% of epilepsy patients and was associated with non-adherence and poor seizure control. Depression increased the risk of poor control by about 16-folds. Non-adherence was associated with depression and poor sleep quality and was one of the predictors of poor epilepsy control. Conclusion Depression and poor sleep quality can impair the outcome of PWE and also there is a strong association between depression and poor sleep quality among PWE and both impair seizure control.