Division of Neurology, Trinity Hospital, Borgomanero, Italy.
Bipolar Disord. 2013 Aug;15(5):622-7. doi: 10.1111/bdi.12091. Epub 2013 Jun 12.
The standardized mortality ratio for suicide in people with epilepsy is reported as 5.1 [95% confidence interval (CI): 3.9-6.6], but this is only partially explained by the high rates of psychiatric comorbidity. This issue was revived when, in 2008, the Food and Drug Administration (FDA) issued an alert on an increased risk of suicide in people taking antiepileptic drugs (AEDs). We discuss and elaborate on available evidence on the interplay among epilepsy, suicide, and AEDs, taking into account the phenomenology of mood disorders in people with epilepsy and the psychotropic potential of AEDs.
Articles were identified by searches of Medline/PubMed using the terms epilepsy, antiepileptic drugs, and suicide. Only papers published in English in international peer-reviewed journals were considered. The reference lists of relevant articles were hand-searched for additional publications (e.g., book chapters or review papers) if relevant to the discussion.
The results of studies supporting or opposing the FDA conclusions have been inconsistent. This may be due to a number of methodological limitations, such as the failure to adjust for past suicidality and the confounding effect of epilepsy.
A subgroup of people with epilepsy appears to be at risk of developing treatment-emergent psychiatric adverse effects of AEDs independently of the specific mechanism of action of the drug. Clinicians need to pay attention not only to seizure patterns when choosing the appropriate AED but also to a number of different parameters, not least the mental state of the individual patient.
癫痫患者的自杀标准化死亡率报告为 5.1[95%置信区间（CI）：3.9-6.6]，但这仅部分解释了精神共病的高发病率。当 2008 年美国食品和药物管理局（FDA）发布关于抗癫痫药物（AEDs）使用者自杀风险增加的警报时，这个问题再次出现。我们讨论并详细阐述了癫痫、自杀和 AEDs 之间相互作用的现有证据，同时考虑到癫痫患者心境障碍的现象学和 AEDs 的精神治疗潜力。
通过使用术语癫痫、抗癫痫药物和自杀在 Medline/PubMed 上搜索文章。仅考虑在国际同行评议期刊上以英文发表的论文。如果与讨论相关，还会手动搜索相关文章的参考文献列表以获取其他出版物（例如，书章节或评论文章）。
支持或反对 FDA 结论的研究结果不一致。这可能是由于许多方法学限制造成的，例如未能调整既往自杀倾向和癫痫的混杂效应。
似乎有一小部分癫痫患者在出现与药物特定作用机制无关的 AED 治疗相关的精神不良事件的风险增加。临床医生不仅在选择合适的 AED 时需要注意癫痫发作模式，还需要注意许多不同的参数，尤其是个体患者的精神状态。
