Antiepileptic drugs and the risk of suicide in patients with epilepsy

Abstract

It is estimated that the risk of suicide in epileptic patients is about three times higher than in the general population. Suicide risk factors in this group of patients include age, gender, socio-economic factors, history of psychiatric disorders and epilepsy itself. According to a warning issued by the Food and Drug Administration in 2008, which was based on a meta-analysis of randomised controlled trials of 11 compounds, antiepileptic drugs are one of them. This warning was criticised by many investigators and the International League Against Epilepsy task force because of methodological limitations. Although some of the antiepileptic drugs may have negative influence on mood, contributing to suicidal ideation, the actual risk of suicide seems to be low. It should be taken into account that the discontinuation of antiepileptic therapy may increase the risk of suicide to a greater extent than taking antiepileptic drug alone. A recent meta-analysis did not confirm the increased risk of suicide in patients treated with antiepileptics. Almost 15 years after the Food and Drug Administration issued the alert about an increased suicidality risk with antiseizure medications, there is still considerable debate on this subject. The available literature data has shown no obvious causal relationship between antiseizure medications and the risk of suicide. The authors of the studies point to the complex relationship between suicide and epilepsy, highlighting the bidirectional relationship and the influence of many factors.