H. M.
Clary and F. Gilliam addressed this topic in a Neurology publication.1
People with epilepsy are prone to depression and anxiety. This is not news for
our friends afflicted with seizures. People with epilepsy have a 22% higher
rate of epilepsy than the general population.2
The risk
of suicidality is highest shortly after the onset of epilepsy. The
International League Against Epilepsy practice recommendation calls for
neurologists to identify and manage depression and anxiety in their patients at
every clinic visit.
Mood and
anxiety diagnoses and suicidality among 347 adults with newly diagnosed focal
epilepsy diagnoses were evaluated from the multicenter Human Epilepsy Project.
An analysis revealed a high prevalence of psychiatric diagnoses that may go undetected:
bipolar disorder, panic disorder, and agoraphobia stood out. There were strong
associations of these diagnoses with suicidality, no different from those with
established epilepsy.3
What is Suicidality?
The American Psychological Association defines suicidality as “the risk of
suicide, usually indicated by suicidal ideation or intent, especially as
evident in the presence of a well-elaborated suicidal plan.” It also to includes
suicidal thoughts, plans, gestures, or attempts.
Bipolar
disorder was more common than major depressive disorder. Sixteen percent had
this diagnosis. Panic disorder was nearly as common as generalized anxiety,
present in 11.5% of all participants. Nearly 39% had a mood or anxiety disorder
and more than one-third of these had suicidality.
This
overall assessment has implications for the clinical care of people with
epilepsy as newly diagnosed focal epilepsy and established epilepsy may have
suicide risk associated with psychiatric diagnoses not routinely screened for
in epilepsy clinics. This knowledge elevates the need to better detect bipolar
disorder, panic disorder and agoraphobia in our clinics.
Do not hesitate to consult with
your physicians and caregivers if you, the patient, or the patient within your
circle exhibits suicidal thoughts/actions. Do not fear that if you query the
patient of possible suicidality thinking your mentioning the topic could be
harmful. No, it’s almost always welcomed and helpful. As always, I recommend
significant others of the patient accompany the patient to the clinic
appointment. Much useful information often comes to light.
1. Clary H.M., Gilliam F. Suicidality
in Epilepsy. Neurology. 2023: Vol 100; No. 11, p 499-500.
2. Tian N, Cui W, Zack M et.al. Suicide
among people with epilepsy: a population-based analysis of data from the U.S.
National Violent Death Reporting System, 17 states 2003-2011. Epilepsy
Behav. 2016, 61:210-217.
3.
Kanner
A., Saporta A., Kim D, et.al. Mood and Anxiety Disorders and Suicidality in
Patients with Newly Diagnosed Focal Epilepsy. Neurology. 2023: vol 100; No.
11 p 508-509.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.
