Blog #168: Suicidality ˗˗˗ Epilepsy

 

 

 

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.