Report of the WPA section of pharmacopsychiatry on the relationship of antiepileptic drugs with suicidality in epilepsy

Abstract

Introduction. This report from the World Psychiatric Association Section on Pharmacopsychiatry examines the possible relationship of antiepileptic drugs with suicide-related clinical features and behaviors in patients with epilepsy. Materials and methods. A systematic review of the MEDLINE search returned 1039 papers, of which only 8 were considered relevant. A critical analysis of the Food and Drug Administration (FDA) report on the increase risk for patients under antiepileptics to manifest suicidality is also included in this report. Results. The analysis of these studies revealed that the data are not supportive of the presence of a “class effect” on suicide-related behavior; on the contrary, there are some data suggesting such an effect concerning treatment with topiramate, lamotrigine, and levetiracetam for which further research is needed. Discussion. For the majority of people with epilepsy, anticonvulsant treatment is necessary and its failure for any reason is expected to have deleterious consequences. Therefore, clinicians should inform patients and their families of this increased risk of suicidal ideation and behavior, but should not overemphasize the issue. Specific subgroups of patients with epilepsy might be at a higher risk, and deserve closer monitoring and follow-up. Future research with antiepileptics should specifically focus on depression and suicidal thoughts.

Key words::

• Antiepileptics
• suicidality
• anticonvulsants

Acknowledgement

None.

Statement of interest

Konstantinos N. Fountoulakis received honoraria for lectures or for advisory activities or received support for participating in congresses by Astra-Zeneca, Eli Lilly, Janssen, Lundbeck, Pfizer, Servier, and others. He has received research grants from Pfizer foundation.

Xenia Gonda has no conflict of interest. She is a recipient of the János Bolyai Scientific Fellowship of the Hungarian Academy of Sciences.

Thomas C. Baghai received payment for consultancy, for lectures, and for manuscript preparation, and travel/accommodation grants from AstraZeneca, GlaxoSmithKline, Janssen-Cilag, Organon, Pfizer, and Servier.

David S. Baldwin on behalf of his employer DSB has held research grants from Bristol-Myers Squibb, Cephalon, Eli Lilly Ltd, GlaxoSmithKline, H. Lundbeck A/S, Pierre Fabre, Pfizer Ltd, Roche, and Vernalis Ltd. He has served on advisory boards hosted by Astra-Zeneca, Bristol-Myers Squibb, Eli Lilly Ltd, GlaxoSmithKline, Grunenthal, H. Lundbeck A/S, Pierre Fabre, and Pfizer Ltd. He is a past President of Depression Alliance and current Medical Patron of Anxiety, UK.

Michael Bauer has received grant/research support from The Stanley Medical Research Institute, NARSAD, Deutsche Forschungsgemeinschaft, European Commission (FP7), American Foundation for Suicide Prevention, and Bundesministerium für Bildung und Forschung (BMBF). He is/has been a consultant for Alkermes, AstraZeneca, BristolMyers Squibb, Ferrer Internacional, Janssen, Lilly, Lundbeck, Otsuka, Servier, and Takeda, and has received speaker honoraria from AstraZeneca, BristolMyers Squibb, Ferrer Internacional, GlaxoSmithKline, Lilly, Lundbeck, Otsuka, and Pfizer.

Pierre Blier has no conflict of interest.

Wagner Gattaz has no conflict of interest.

Gregor Hasler has received speaker and consulting honoraria from Lundbeck, AstraZeneca, Takeda, Servier, Eli Lilly, and Novartis. These honoraria are not related to the writing of this article.

Hans-Jürgen Möller received honoraria for lectures or for advisory activities or received grants from the following pharmaceutical companies: Astra-Zeneca, Eli Lilly, Janssen, Lundbeck, Pfizer, Schwabe, Servier, Otsuka, and Takeda. He was president or in the Executive Board of the following organizations: CINP, ECNP, WFSBP, EPA, and chairman of the WPA Section on Pharmacopsychiatry.

Rajiv Tandon has no conflict of interest relevant to the current study.

Eduard Vieta has received grants and served as consultant, advisor, or CME speaker for the following entities: Adamed, Alexza, Almirall, AstraZeneca, Bial, Bristol-Myers Squibb, Elan, Eli Lilly, Ferrer, Forest Research Institute, Gedeon Richter, Glaxo-Smith-Kline, Janssen-Cilag, Jazz, Johnson & Johnson, Lundbeck, Merck, Novartis, Organon, Otsuka, Pfizer, Pierre-Fabre, Qualigen, Roche, Rovi, Sanofi-Aventis, Servier, Shering-Plough, Shire, Solvay, Sunovion, Takeda, Teva, the Spanish Ministry of Science and Innovation (CIBERSAM), the Seventh European Framework Programme (ENBREC), the Stanley Medical Research Institute, United Biosource Corporation, and Wyeth.

Siegfried Kasper has received grant/research support from Bristol Myers-Squibb, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Pfizer, Sepracor, and Servier; he has served as a consultant or on advisory boards for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, Lundbeck, Merck Sharp and Dome (MSD), Novartis, Organon, Pfizer, Schwabe, Sepracor, and Servier; and he has served on speakers’ bureaus for Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Bristol Myers-Squibb, Eli Lilly, Janssen, Lundbeck, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe, Sepracor, Servier, and Wyeth.