Antiepileptic drugs and suicidality

Abstract

People with epilepsy are at a higher risk of premature death and suicide is one of the main culprits. It is well-recognized that suicide is more common in people with epilepsy, although estimates vary considerably concerning the magnitude of the risk. A recent meta-analysis estimated the overall standardized mortality ratio (SMR) for suicide in epilepsy as 3.3 (95% confidence interval 2.8-3.7). The SMR, however, ranges between 2.1 for people with newly diagnosed epilepsy in the community and 13.9 in those following temporal lobe resections.1 The Food and Drug Administration (FDA) issued an alert regarding an excess risk of suicidality in people taking antiepileptic drugs (AEDs) in 2008.2 The FDA had previously asked drug companies to submit data from placebo-controlled trials of AEDs, regardless of indication, provided that at least 30 patients were involved in such trials. A meta-analysis was then carried out by the FDA and it suggested an overall increased risk for suicidal behavior or ideation. As a result, manufacturers of AEDs were asked to include a warning in their labeling and develop a medication guide for patients, informing them of the risks of suicidal thoughts or behaviors.3 Some have suggested that the FDA's concern might be excessive4,5; that …