Suicidality in Epilepsy: Does It Share Common Pathogenic Mechanisms with Epilepsy?

Hečimović, Hrvoje; Popović, Zvonimir; Gilliam, Frank

doi:10.1007/7854_2021_220

Cited by 3 publications

(4 citation statements)

References 93 publications

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“…(iii) Decreased neurotrophins (BDNF) (iiii) Neuro-immune dysfunction, including increased cytokine secretion. For detail reviews by Kanner (2006) and Hecimovic et al (2021) .…”

Section: Common Pathogenic Mechanisms Between Suicidality and Epilepsymentioning

confidence: 99%

“…The role of a hyperactive hypothalamic–pituitary–adrenal axis (HPAA) in suicidality has well been established, as evidenced by high cortisol serum concentrations in patients who died from suicide ( Kanner, 2006 ; Hecimovic et al, 2021 ). Furthermore, a hyperactive HPAA has been identified in the comorbid psychiatric disorders associated with suicidality such as mood, anxiety disorders, and chronic stress ( Sapolsky, 2000 ; Kanner, 2006 ; Hecimovic et al, 2021 ). For example, the non-suppression of cortisol in response to the dexamethasone administration test (DST), is a measure of the HPAA function.…”

Section: Common Pathogenic Mechanisms Between Suicidality and Epilepsymentioning

confidence: 99%

“…Finally, neuroimmune dysfunction has also been postulated as a common pathogenic mechanism operant in suicidality and its comorbid psychiatric disorders and in epilepsy ( Vezzani et al, 2008 ; Black and Miller, 2015 ; Brundin et al, 2017 ; Kanner et al, 2018 ; Hecimovic et al, 2021 ). The release of proinflammatory cytokines such as interferon-α (IFN-α), tumor necrosis factor-α (TNF-α), IL-6, and IL-1β are pivotal players in epilepsy and psychiatric disorders ( Vezzani et al, 2008 ; Hecimovic et al, 2021 ).…”

Section: Common Pathogenic Mechanisms Between Suicidality and Epilepsymentioning

confidence: 99%

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Suicidality in Patients With Epilepsy: Why Should Neurologists Care?

Kanner

2022

Front. Integr. Neurosci.

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Suicidality is a relatively common comorbidity in patients with epilepsy (PWE). Population-based studies have revealed lifetime prevalence rates of 25% of suicidal ideation (SI). In addition, PWE without comorbid psychiatric disorders has two to three higher risk of committing suicide and this risk increases by 12- to 32-fold in the presence of various psychiatric disorders. Risk factors are multiple and include socio-demographic, genetic, age and gender, and psychiatric comorbidities. Among the latter, mood, anxiety, and psychotic disorders have been found to be common risk factors for suicidality in PWE, but iatrogenic causes resulting from pharmacotherapy with antiseizure drugs or epilepsy surgery can also cause SI and behavior. Suicidality and epilepsy have a complex bidirectional relation, whereas PWE are at increased risk of suicidality and vice-versa. Common pathogenic mechanisms operant in both conditions may explain this bidirectional relation. SI can be easily identified in outpatient epilepsy clinics with screening instruments and can be treated and thus prevent its escalation to suicidal attempts and completed suicide. The aim of this manuscript is to review these data in detail.

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“…(iii) Decreased neurotrophins (BDNF) (iiii) Neuro-immune dysfunction, including increased cytokine secretion. For detail reviews by Kanner (2006) and Hecimovic et al (2021) .…”

Section: Common Pathogenic Mechanisms Between Suicidality and Epilepsymentioning

confidence: 99%

Section: Common Pathogenic Mechanisms Between Suicidality and Epilepsymentioning

confidence: 99%

Section: Common Pathogenic Mechanisms Between Suicidality and Epilepsymentioning

confidence: 99%

See 1 more Smart Citation

Suicidality in Patients With Epilepsy: Why Should Neurologists Care?

Kanner

2022

Front. Integr. Neurosci.

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“…In contrast, people with suicidality have a higher risk of developing epilepsy. Common pathogenic mechanisms in epilepsy and suicidality are hypothesized to explain this bidirectional relation [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

Mood disorders in adults with epilepsy: a review of unrecognized facts and common misconceptions

Kanner,

Shankar,

Margraf

et al. 2024

Ann Gen Psychiatry

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Epilepsy is one of the most common neurologic conditions. Its clinical manifestations are not restricted to seizures but often include cognitive disturbances and psychiatric disorders. Prospective population-based studies have shown that people with epilepsy have an increased risk of developing mood disorders, and people with a primary mood disorder have an increased risk of developing epilepsy. The existence of common pathogenic mechanisms in epilepsy and mood disorders may explain the bidirectional relation between these two conditions. Recognition of a personal and family psychiatric history at the time of evaluation of people for a seizure disorder is critical in the selection of antiseizure medications: those with mood-stabilizing properties (e.g., lamotrigine, oxcarbazepine) should be favoured as a first option in those with a positive history while those with negative psychotropic properties (e.g., levetiracetam, topiramate) avoided. While mood disorders may be clinically identical in people with epilepsy, they often present with atypical manifestations that do not meet ICD or DSM diagnostic criteria. Failure to treat mood disorders in epilepsy may have a negative impact, increasing suicide risk and iatrogenic effects of antiseizure medications and worsening quality of life. Treating mood disorders in epilepsy is identical to those with primary mood disorders. Yet, there is a common misconception that antidepressants have proconvulsant properties. Most antidepressants are safe when prescribed at therapeutic doses. The incidence of seizures is lower in people randomized to antidepressants than placebo in multicenter randomized placebo-controlled trials of people treated for a primary mood disorder. Thus, there is no excuse not to prescribe antidepressant medications to people with epilepsy.

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