Suicide and epilepsy

PURPOSE OF REVIEW: For many years, it has been accepted that suicide may be more common in people with epilepsy. Recent studies have investigated risk factors. RECENT FINDINGS: Studies have shown that a history of psychiatric disease increases the risk of suicide in a person with epilepsy but have also shown that the risk of suicide in people with epilepsy is increased in the absence of a psychiatric history. People with epilepsy may have undiagnosed and untreated psychiatric illness, and depression (both reactive and endogenous) may occur. Studies have suggested that the relationship between seizures and depression or suicidal behaviour may be bidirectional, and both major depression and attempted suicide increase the risk of developing seizures. Forced normalization and postictal psychosis may also contribute to suicidal behaviour. Antiepileptic drugs have been implicated in causing psychiatric adverse effects and suicidal behaviour. SUMMARY: It is important to take an holistic approach when evaluating and monitoring people with epilepsy. Clinicians should screen for depression and treat appropriately. The choice of which antiepileptic drug to use may also be influenced by the presence of depression or suicidal ideation.