Mula Marco, Hesdorffer Dale C
Department of Clinical and Experimental Medicine, Amedeo Avogadro University and Division of Neurology, University Hospital Maggiore della Carità, Novara, Italy;
Drug Healthc Patient Saf. 2011;3:15-20. doi: 10.2147/DHPS.S13070. Epub 2011 Jun 16.
Two years after the warning issued by the Food and Drug Administration on an increased risk of suicide for people taking antiepileptic drugs (AEDs), a number of pharmacoepidemiologic studies have been published but the scientific community is far from definitive answers. The present paper is aimed at reviewing available evidence on the association between AEDs and suicidal behavior, discussing major variables involved such as the relationship between epilepsy, depression, and suicide and the psychotropic potential of AEDs. All studies published so far show a lack of concordance and are constrained by various methodological limitations. What seems to be established is that mood disorders represent a frequent comorbidity in epilepsy and suicide is a serious complication more frequently encountered in epilepsy rather than in the general population. Moreover, a subgroup of patients appears to be at risk of developing treatment-emergent psychiatric adverse effects of AEDs independently of the specific mechanism of action of the drug. The prior history of suicide attempt, especially preceding the onset of the epilepsy, may represent a key element explaining why what is observed is independent of the specific mechanism of the drug. In general terms, risks associated with stopping, or not even starting, AEDs in epilepsy might well be in excess of the risk of suicide in epilepsy, as deaths due to accident and epilepsy itself may predominate. Clinicians need to pay attention not only to seizure patterns when choosing the appropriate AED but also to a number of different parameters (eg, age, gender, working needs, medical comorbidities, history of psychiatric disorders, and suicidality before epilepsy onset) and not the least the mental state of the patient. Missing severe complications such as suicidal behavior or delaying its treatment may worsen the prognosis of epilepsy.
在食品药品监督管理局就服用抗癫痫药物（AEDs）的人群自杀风险增加发出警告两年后，多项药物流行病学研究已发表，但科学界仍远未得出明确答案。本文旨在综述关于AEDs与自杀行为之间关联的现有证据，讨论所涉及的主要变量，如癫痫、抑郁和自杀之间的关系以及AEDs的精神药物作用潜力。迄今为止发表的所有研究都缺乏一致性，且受到各种方法学限制的约束。似乎已确定的是，情绪障碍是癫痫中常见的共病情况，自杀是癫痫中比普通人群更常遇到的严重并发症。此外，有一组患者似乎有发生AEDs治疗引发的精神不良反应的风险，这与药物的具体作用机制无关。自杀未遂的既往史，尤其是在癫痫发作之前，可能是解释为何观察到的情况与药物的具体机制无关的关键因素。一般而言，癫痫患者停用AEDs或甚至不开始使用AEDs所带来的风险很可能超过癫痫患者的自杀风险，因为意外死亡和癫痫本身导致的死亡可能占主导。临床医生在选择合适的AEDs时不仅要关注癫痫发作模式，还要关注许多不同的参数（如年龄、性别、工作需求、合并症、精神疾病史以及癫痫发作前的自杀倾向），尤其是患者的精神状态。漏诊自杀行为等严重并发症或延误其治疗可能会使癫痫的预后恶化。
