Suicide-Related Events in Patients Treated with Antiepileptic Drugs

Abstract

The current use of antiepileptic drugs was not associated with an increased risk of suicide-related events among patients with epilepsy, but it was associated with an increased risk of such events among patients with depression and among those who did not have epilepsy, depression, or bipolar disorder.

Antiepileptic Drugs and Suicide: A Systematic Review of Adverse Effects

“…On the one hand, Arana et al [22] reported an association between suicide and the use and nonuse of AEDs in 11 cohorts and concluded that the increased risk was dependent on the underlying disease. On the other hand, they also reported an increased risk of suicide in patients on AEDs without epilepsy, depression or bipolar disorder (OR 2.57, 95% CI 1.78-3.71).…”

“…Andersohn et al [23] showed that only AEDs with high risk of depression were associated with an increased risk of suicide in epilepsy patients (OR 3.08, 95% CI 1.22-7.77). In both studies [22,23], the results could be biased by confounding by indication. Furthermore, there was a possibility of nondifferential outcome misclassification because suicides may have been underestimated.…”

“…The small numbers of cases and controls could have also decreased the power of the study to detect an effect, particularly for individual drugs. In the study of Arana et al [22], the authors excluded all individuals with a familial or personal history of suicide, which could have led to an overall underestimation of the risk of suicide.…”

“…Concerning individual drugs, studies have shown an increased risk of suicide for patients taking phenobarbital (1 study [21]), phenytoin (1 study [17]), carbamazepine (1 study [22]), valproic acid (3 studies [17,21,22]), lamotrigine (3 studies [2,17,21]), topiramate (3 studies [2,17,18]), gabapentin (1 study [17]) and levetiracetam (2 studies [17,23]). However, a similar number of studies demonstrated a protective effect - valproic acid (1 study [23]) and gabapentin (1 study [19]) - or no effect - phenobarbital (2 studies [17,23]), phenytoin (2 studies [21,23]), valproic acid (3 studies [2,18,22]), lamotrigine (5 studies [18,22,23,25,26]), topiramate (2 studies [22,23]), gabapentin (5 studies [2,18,21,22,23]), levetiracetam (3 studies [2,22]) and oxcarbazepine (3 studies [2,18,21]) - of these AEDs on suicide.…”

Modulation of Immunity and the Inflammatory Response: A New Target for Treating Drug-resistant Epilepsy

“…Therefore, drug resistance in epilepsy is equally obvious and prompts a maintained interest towards both the clinical aspects and the biological mechanisms of drug intractability in epilepsy. Moreover, many of the drugs are associated with severe side effects, which include psychiatric side effects, increased risk of suicide [10], and fatal hepatotoxicity [11]. Persistent seizures have negative psychosocial, behavioral, cognitive, and financial consequences and are associated with an increased mortality rate [9-12].…”