Almost half of patients with newly diagnosed focal epilepsy have experienced a mood disorder, anxiety disorder, or both, and approximately a quarter of these patients present with suicidality, researchers reported at AES2020, the virtual annual meeting of the American Epilepsy Society.
The findings underscore the need for vigilance about mental health issues for epilepsy right at the time of diagnosis, the research team said. Patients with epilepsy have a risk of death by suicide that is 10 times higher than the general population, and mood and anxiety disorders have been linked with suicidal thoughts and behavior.
“In neurology, we are now starting to appreciate the importance of recognizing psychiatric comorbidities," said the presenting author Andres M. Kanner, MD, FAAN, director of the International Comprehensive Epilepsy Center at the University of Miami Miller School of Medicine. “For a long time, these were something that nobody paid attention to."
Researchers pulled data for 366 people newly diagnosed with non-lesional focal epilepsy—those who had been treated with antiepileptic medications for less than four months—from the Human Epilepsy Project, a group of more than 300 doctors, researchers, health care workers, and patients working internationally to study biomarkers in new-onset epilepsy. They identified mood and anxiety disorders using the MINI International Neuropsychiatric Interview. Also, they assessed current and lifetime active suicidal ideation and suicide attempts using the Columbia Suicide Severity Rating Scale.
They found 162 of the subjects—or 44.3 percent—met the criteria for a mood, anxiety disorder, suicidality, or any combination of these; 143 subjects had a mood or anxiety disorder, or both —and 14 percent did have both.
They observed major depressive disorder in 9.5 percent of the patients, and bipolar disorder in 8.5 percent. The most common anxiety disorder was generalized anxiety (14.5 percent), followed by panic disorder (12 percent). Ten percent of patients had more than one type of anxiety disorder.
Eighty-two patients (22.4 percent) met the criteria for active and/or passive suicidal ideation or they had made a suicide attempt. Fourteen percent had experienced suicidal ideation at some point in their lifetime, and 5 percent of patients had active suicidal ideation within the previous six months. Seventeen patients, or 4.6 percent, had made a suicide attempt at some point in their lives.
Bipolar disorder was most closely associated with lifetime suicide attempts, with an odds ratio of 22.4 compared to those without bipolar disorder (p=0.0001), followed by major depression with an OR of 17.3 (p=0.0001). Panic disorder was the strongest predictor of current suicidal ideation (OR = 12.9; p=0.0001). Lifetime suicidal ideation was also predicted most strongly by panic disorder (OR = 14.6; p=0.0001).
“Very often, people think of these comorbid conditions as a consequence of chronic epilepsy, and our data show a significant number of people, by the time they are diagnosed with epilepsy, may have already been suffering from these conditions," Dr. Kanner said. “And you have to identify them on the first visit when you're evaluating these patients for epilepsy."
When these disorders are found, he said, that can have important implications for treatment.
“You need to factor in these psychiatric disorders into the selection of your antiepileptic medication," Dr. Kanner said. Someone with a history of depression shouldn't be prescribed a medication with negative psychotropic properties, he added.
Dr. Kanner noted the data also show the relatively high frequency with which these patients ponder or attempt suicide.
“Twenty-five percent of patients already have experienced suicidal ideation by the time the epilepsy is diagnosed," he said. “It's something you have to recognize."
Gregory L. Krauss, MD, professor of neurology at Johns Hopkins, said the findings are cause for exploring these connections more deeply.
“The study shows a strong relationship between mood and anxiety disorders and having suicidality symptoms in patients with newly diagnosed focal epilepsy," he said. “The high proportion with suicidality (22 percent) and suicidal attempts (4.6 percent) in this group is striking and should be explored further, including biological effects of focal epilepsy on mood and anxiety."
Dr. Kanner has no relevant disclosures. Dr. Krauss has received fees for consulting for Arvelle Labs and SK LifeScience.
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AES Abstract 970: Kanner A, Kim DH, Anita S, et al. Which of the mood and anxiety disorders are the strongest predictors of suicidality in newly diagnosed non-lesional focal epilepsy?