Objective To investigate the depressive state and the features of ecological executive function in adults with epilepsy.Methods Depressive state and ecological executive function were assessed in 96 adults with epilepsy and 54 normal ones with matched sex, age, and educational level, with the application of Hamilton Depression Scale and Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A).Results The patients with epilepsy had a significantly higher incidence rate of depressive disorder than those in the normal control group (P<0.01). Multiple stepwise linear regression analysis showed that economic income and disease control were closely related to the incidence of epilepsy complicated by depressive disorder (P<0.01). The epilepsy-depression group and epilepsy-non-depression group had significantly higher BRIEF-A total score and scores on all BRIEF-A subscales than the control group (P<0.01); compared with the epilepsy-non-depression group, the epilepsy-depression group had significantly higher BRIEF-A subscale scores except those on Inhibit, Emotional Control, and Plan/Organize subscales (P<0.05).Conclusions The adults with epilepsy have a high incidence rate of depression, and those with depression have obvious disorders of ecological executive function. The diagnosis and treatment of epilepsy with depression should be emphasized in clinical practice.