Epilepsy, antiepileptic drugs and suicidality.

PURPOSE OF REVIEW: The risk of suicide is thought be increased in epilepsy. Antiepileptic drugs (AEDs) remain the primary treatment. An FDA alert in 2008 raised concerns that AEDs may increase the risk of suicidal thoughts and behaviour. The risk profile for suicide in epilepsy is examined in the context of recent reports investigating the risk of suicide and the reported association between AEDs and risk of suicide.

RECENT FINDINGS: Following a diagnosis of epilepsy the risk of completed suicide is increased (standardized mortality ratio 2-3.5); although the causes remain poorly understood, co-morbid depression and the first 6 months after epilepsy surgery seem to be particular risk factors. The evidence for AEDs increasing risk for suicide remains mixed and is based on retrospective data.

SUMMARY: The identification of risk factors such as mood or anxiety disorders in patients with epilepsy should not delay AED treatment as the risks associated with seizures far outweigh the current research evidence for increased AED-related suicide risk. A pragmatic approach to clinical assessment and management is suggested. Prospective AED trials should include validated scales to systematically identify neuropsychiatric complications of AEDs.