Suicidal Behavior and Psychiatric Comorbidity in Epilepsy

Epilepsy is a neurological disorder characterised by recurrent seizures, but its impact extends well beyond paroxysmal electrical disturbances. People with epilepsy experience disproportionately high rates of mood and anxiety disorders, psychotic symptoms and substance misuse, all of which compound the risk of suicidal behaviour. Suicidal ideation is reported in up to a quarter of those affected and rates of suicide attempts and completed suicide exceed those in the general population by two- to three-fold. Risk is influenced by a complex interplay of biological, psychosocial and iatrogenic factors: seizure frequency, temporal lobe pathology, exposure to certain antiseizure medications, pre-existing depression or anxiety, unemployment, poor social support and stigma all contribute. Emerging evidence suggests a bidirectional relationship between epilepsy and mood disorders, underpinned by shared neurobiological mechanisms in limbic networks and stress pathways. Clinically, this mandates routine screening for suicidal thoughts, collaborative care between neurology and mental health services, and judicious selection of pharmacotherapy to mitigate iatrogenic risk while addressing comorbid psychiatric symptoms.

Research from Nature Portfolio

A large nested case–control study in West China assessed over 2,000 adults with epilepsy to identify independent predictors of suicidal tendency. Multivariate analysis revealed that unemployment, use of levetiracetam, clinically significant depression and perceived stigma remained robust risk factors. Decision-tree modelling indicated that standardised scales for stigma and depression could effectively stratify patients at highest risk. The findings underscore the need for socioeconomic support, stigma reduction initiatives and careful monitoring of mood symptoms when prescribing specific antiseizure drugs.

Suicidal Behavior and Psychiatric Comorbidity in Epilepsy publication trend

The graph below shows the total number of articles in suicidal behavior and psychiatric comorbidity in epilepsy across all publications each year (not limited to Nature Index journals).

Technical terms

Suicidal ideation: Thoughts or preoccupations with ending one’s life, ranging from fleeting considerations to concrete planning.

Antiseizure medication: A class of drugs prescribed to reduce the frequency or severity of epileptic seizures.

Psychiatric comorbidity: The co-occurrence of one or more mental health disorders in individuals diagnosed with epilepsy.

Stigma: Negative beliefs, attitudes and social exclusion directed at individuals because of their epilepsy or psychiatric illness.

References

1. Suicidality in Patients With Epilepsy: Why Should Neurologists Care?. Frontiers in Integrative Neuroscience (2022).
2. Risk factors for suicidal tendency in people with epilepsy in China: a case–control study. Scientific Reports (2021).
3. A Meta-Analysis of the Rates of Suicide Ideation, Attempts and Deaths in People with Epilepsy. International Journal of Environmental Research and Public Health (2019).
4. Incidence, methods and circumstances of suicide in epilepsy: A population-based study in Sweden. Epilepsy & Behavior (2024).