Exploring the Complex Relationship Between Antiepileptic Drugs and Suicidality: A Systematic Literature Review

Area of Science:

• Neurology
• Psychiatry
• Pharmacology

Background:

• Patients with epilepsy face a significantly elevated risk of suicide, approximately three times higher than the general population.
• This risk persists even when accounting for sociodemographic factors and the absence of mental health comorbidities.
• Concerns regarding suicidality and antiepileptic drugs (AEDs) led to a US Food and Drug Administration (FDA) black box warning, prompting further investigation.

Purpose of the Study:

• To systematically review existing literature on the relationship between AEDs and suicidality specifically in the context of epilepsy treatment.
• To clarify the ambiguous findings from previous studies regarding AEDs and suicide risk in epilepsy patients.

Main Methods:

• A comprehensive literature search was performed on PubMed.
• The search encompassed all time periods and utilized a predefined search strategy.
• Eight studies were included in the final review after a systematic screening of 443 articles based on predefined inclusion and exclusion criteria.

Main Results:

• Three studies indicated a significant association between levetiracetam and suicide-related behaviors in epilepsy patients.
• One study found a link between pregabalin use, younger age, and high AED load with suicidality, independent of depression.
• Four studies identified a correlation between a history of psychiatric comorbidities and suicidality in individuals with epilepsy.

Conclusions:

• This review suggests an association between levetiracetam use, mental health comorbidities, and suicidality in epilepsy patients.
• Methodological limitations were noted in the reviewed studies.
• Larger prospective, randomized studies are necessary to establish definitive evidence regarding AEDs and suicidality in epilepsy.