Abstracts

Rationale: Suicide rates among patients with epilepsy are higher than the general population. The FDA recently announced a requirement that product labeling for all antiepileptic drugs (AEDs) include a warning that their use increases risk of suicidal thoughts and behaviors (suicidality). This study examines the relationship among co-morbid depression, suicidal ideation, and antiepileptic drugs in a cohort of epilepsy patients. Methods: Analyses were conducted on a longitudinal database from the epilepsy program at the University of Florida from 01/2006 to 08/2008. Neurological disorders depression inventory for epilepsy (NDDI-E) was used to measure changes in mood. An item in NDDI-E related to suicidal ideation was used to measure changes in thoughts of suicide. Informed consent to include their information in the database was obtained in 790 patients with epilepsy; 163 patients were included in this study who had completed the NDDI-E and had drug information at more than one time point (mean = 173 days; range = 21-790). Changes in mood and suicidal ideation were compared among the following groups: 1) no AED change, 2) new AED added, 3) AED dose increased, 4) AED reduced/stopped, 5) multiple AED changes, and 6) total AED changes (i.e., groups 2-5 combined). Results: No group had worsening mood or increased suicidality. Significant improvements in mood were seen for no AED change (p<0.01), add new AED (p<0.01), and total AED change groups (p<0.05). Significant improvements in suicidality were seen for the no AED change group (p<0.01). Compared to the no change group, increase dose group had less improved mood (p<0.05), and the total AED change group had less reduction in suicidality (p<0.01). Conclusions: Irrespective of AED treatment changes, mood and suicidality did not worsen. Overall, most patients had improved mood and reduced suicidality. Additional research is needed to further delineate risk of depression and suicidality in patients with epilepsy.