Summary Purpose:  Depression is an important but underdiagnosed complication of epilepsy. This study compares potentially suitable screening tools head‐to‐head. Methods:  We enrolled 266 attendees with a confirmed diagnosis of epilepsy at a specialized neurologic epilepsy service in London and compared verbal self‐report and visual analog (VAS) screening methods for depression. These included two generic depression scales (Hospital Anxiety and Depression Scale [HADS], Beck Depression Inventory II [BDI‐II]), one epilepsy specific scale (Neurological Disorders Depression Inventory for Epilepsy [NDDI‐E]) and one new visual‐analog scale (Emotional Thermometers [ET]). We used Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM‐IV) criteria for major depression and International Classification of Diseases, Tenth Revision (ICD‐10) criteria for depressive episode as the reference standard. Key Findings:  Against ICD‐10–defined depression the most accurate scales by receiver operating characteristic (ROC) curve area were HADS Total (HADS‐T, 0.924), BDI‐II (0.898) and NDDI‐E (0.897). New visual‐analog methods had similar accuracy measured either in combination or individually. Although no test performed well in a case‐finding role, several performed well as a rule‐out initial step, owing to high negative predictive value and specificity. In this role, the optimal performing conventional tools were the HADS depression subsscale (HADS‐D) and the NDDI‐E and the optimal single VAS were the depression thermometer (DepT) and the distress thermometer (DT). Against DSM‐IV– defined major depression, results were similar with optimal performance by the HADS‐T, BDI‐II, and NDDI‐E, but here the anxiety thermometer (AnxT) as well as DepT and DT also offered good performance. Given that no test performed well in a case‐finding role, we suggest that these tests are used as an initial first step to rule out patients who are unlikely to have depression. Significance:  We suggest that the six‐item NDDI‐E or seven‐item HADS‐D should be considered if a conventional scale is preferred and that the revised ET4 be considered if a visual‐analog method is required. Follow‐up examination and intervention, where indicated, are necessary in all those who screen positive on any measure as these are not intended as diagnostic tools.

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These findings suggest that both somatic and non-somatic symptoms can be valuable when diagnosing depression in epilepsy and should be considered when designing scales for depression in epilepsy. Specific psychological symptoms and specific somatic symptoms are indicative of depression in epilepsy.