Fundació Institut Català de Farmacologia, Barcelona, Spain.
Neuroepidemiology. 2014;42(2):107-20. doi: 10.1159/000356807. Epub 2014 Jan 3.
Since the FDA (Food and Drug Administration) report on antiepileptic drugs (AEDs) and suicide risk was released (2008), several studies have been published on this controversial relationship. This systematic review (SR) gives an updated approach to this health issue.
We searched 6 databases. We ultimately included 11 publications: 4 cohort studies, 1 case-crossover study, 2 community case-control studies, and 4 SRs. Overall, 1 SR described studies already included; 3 studies reported a 2- to 4-fold overall increase in risk; 1 study reported an increased risk of suicide among epilepsy patients on AEDs with high risk of depression; 1study showed a protective effect among epilepsy patients; 2 studies were conducted with patients with bipolar disorder (1 showed a protective effect, whereas the other showed a 3-fold increase in risk of suicide), and the other 3 studies reported results for single AEDs. Several biases affected the published results.
There is no clear evidence of an association between the use of AEDs and an increased risk of suicide because of the heterogeneity in the studies at the clinical and methodological level. A future study should cover all indications for use, retrieve information from a healthcare database, and include a defined set of covariates to avoid bias.
自美国食品和药物管理局（FDA）发布关于抗癫痫药物（AED）与自杀风险的报告（2008 年）以来，已有多项研究涉及这一备受争议的关系。本系统评价（SR）对这一健康问题进行了更新。
我们搜索了 6 个数据库。最终纳入 11 篇文献：4 项队列研究、1 项病例交叉研究、2 项社区病例对照研究和 4 篇 SR。总体而言，1 篇 SR 描述了已纳入的研究；3 项研究报告称风险增加了 2 至 4 倍；1 项研究报告称癫痫患者使用易致抑郁的 AED 自杀风险增加；1 项研究显示癫痫患者具有保护作用；2 项研究针对双相情感障碍患者进行（1 项研究显示保护作用，另 1 项研究自杀风险增加 3 倍），另外 3 项研究报告了单一 AED 的结果。多种偏倚影响了发表的结果。
由于临床和方法学水平的研究存在异质性，没有明确证据表明 AED 的使用与自杀风险增加之间存在关联。未来的研究应涵盖所有适应证，从医疗保健数据库中检索信息，并纳入一组明确的协变量以避免偏倚。
