Causative Factors for Suicide Attempts by Overdose in Epileptics

Mendez, Mario F.; Lanska, Douglas J.; Mañon-Espaillat, Ramon; Burnstine, Thomas H.

doi:10.1001/archneur.1989.00520460041011

Cited by 53 publications

(13 citation statements)

References 30 publications

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“…Interestingly enough, other studies have shown that symptoms of depression can outlast the ictus for up to 2 weeks (16,17) and, at times, have led patients to suicide (8,(25)(26)(27)(28).…”

Section: Periictal Depressionmentioning

confidence: 99%

Depression in Epilepsy: A Common but Often Unrecognized Comorbid Malady

Kanner

Palac

2000

Epilepsy & Behavior

152

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“…Interestingly enough, other studies have shown that symptoms of depression can outlast the ictus for up to 2 weeks (16,17) and, at times, have led patients to suicide (8,(25)(26)(27)(28).…”

Section: Periictal Depressionmentioning

confidence: 99%

Depression in Epilepsy: A Common but Often Unrecognized Comorbid Malady

Kanner

Palac

2000

Epilepsy & Behavior

152

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“…This risk is far greater for epileptics than for other medical patients with comparable degrees of handicap or disability (Mendez et al 1986). Recently, Mendez et al (1989) have provided data that this risk may be related to interictal psychopathological changes, particularly the high prevalence of borderline personality disorder. The relative propensity for various antidepressants to provoke seizures is reported in table I.…”

Section: Alterations In Eeg Activitymentioning

confidence: 99%

Antidepressant Drugs and the Emergence of Suicidal Tendencies

1993

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Although antidepressant medications represent the cornerstone of treatment for patients with moderate to severe clinical depression, they also carry serious risks. There is evidence which suggests that antidepressants can, in rare instances, induce or exacerbate suicidal tendencies. Nine clinical mechanisms have been proposed through which this may occur. These are: (a) energizing depressed patients to act on pre-existing suicidal ideation; (b) paradoxically worsening depression; (c) inducing akathisia with associated self-destructive or aggressive impulses; (d) inducing panic attacks; (e) switching patients into manic or mixed states; (f) producing severe insomnia or interfering with sleep architecture; (g) inducing an organic obsessional state; (h) producing an organic personality disorder with borderline features; and (i) exacerbating or inducing electroencephalogram (EEG) or other neurological disturbances. Epidemiological and controlled studies also provide data on the association between antidepressant drugs and suicidal ideation, attempts and fatalities. These include studies which: (a) suggest that electroconvulsive therapy may be more effective than antidepressant drugs in reducing the frequency of suicide attempts; (b) indicate that antidepressants may differ in their capacity to reduce the frequency of suicide attempts; (c) find that more overdose attempts were made by patients receiving maprotiline than placebo; and (d) suggest that fluoxetine may be associated with a greater risk of inducing de novo suicidal ideation. Evidence suggests that antidepressants may vary by at least 15-fold in the number of fatal overdoses per million prescriptions. Estimated overdose proclivity rates were derived after adjusting the fatal toxicity data by the therapeutic index of the drug. These rates were very consistent between agents with the same pharmacological properties, and correlated well with known overdose risk rates for amitriptyline, mianserin and maprotiline. Estimated overdose proclivity rates suggest that the highly selective noradrenaline (norepinephrine) uptake inhibitors (desipramine, nortriptyline, maprotiline) may be associated with a greater risk for overdose than more mixed uptake inhibitors and monoamine oxidase inhibitors (MAOIs). Antidepressants are not uniformly neutral in regard to suicidal ideation and attempts. Data clearly demonstrate that antidepressants ameliorate suicidal ideation more effectively than placebo in patients with depression. Although antidepressants diminish suicidal ideation in many recipients, about as many patients experience worsening suicidal ideation on active medication as they do on placebo. Furthermore, at least as many patients attempted suicide on fluoxetine and tricyclic antidepressants as on placebo, and more patients attempted to overdose on maprotiline than placebo. These observations suggest that antidepressants may redistribute suicide risk, attenuating risk in some patients who respond well, while possible enhancing risk in others who respond more poorly.(A...

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“…Such an increased risk is sometimes related to co‐morbid psychiatric illnesses, most commonly depression. Some studies have suggested that the risk is particularly high in patients with temporal lobe epilepsy (TLE), 1,4 but this has not been universally accepted 5,6 . In contrast to TLE, little is known about suicidal behavior of patients with idiopathic generalized epilepsy (IGE).…”

mentioning

confidence: 99%

Suicide attempts in adult patients with idiopathic generalized epilepsy

Hara

Akanuma

Adachi³

et al. 2009

Psychiatry Clin Neurosci

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Aims:To study clinical features of adult patients with idiopathic generalized epilepsy with special attention to suicidal behavior. Methods:We reviewed the medical records of 145 consecutive adult patients with electro-clinically confirmed idiopathic generalized epilepsy and identified those with a history of at least one attempted suicide. Clinical variables in relation to their epilepsy and psychiatric conditions were analyzed.Results: Seven patients (4.8%) had a history of suicide attempts with drug overdose, and one of these patients committed suicide after multiple attempts. All attempts were made interictally without direct relation to their epileptic seizures. All had at least one co-morbid mental disorder (two with dual diagnosis). Although their psychiatric diagnoses varied, they all appeared to have increased emotional instability and poor impulse control. Only one patient's attempt was directly associated with her co-morbid depression.Conclusions: Physicians managing people with epilepsies should be aware of psychiatric disturbances and suicidal behavior in idiopathic generalized epilepsy.

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Causative Factors for Suicide Attempts by Overdose in Epileptics

Cited by 53 publications

References 30 publications

Depression in Epilepsy: A Common but Often Unrecognized Comorbid Malady

Depression in Epilepsy: A Common but Often Unrecognized Comorbid Malady

Antidepressant Drugs and the Emergence of Suicidal Tendencies

Suicide attempts in adult patients with idiopathic generalized epilepsy

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