Many of these patients report a family history of psychiatric illness, usually mood disorders (Kanner et al 2000). Epilepsy and depression may share common pathogenic transmitter mechanisms involving decreased serotonergic, noradrenergic, dopaminergic, and GABAergic activity (Kanner et al 2002; Kanner 2005). Seizure type has been shown to correlate neurologically with depression, which is more common in patients with complex partial seizures, particularly those of temporal lobe origin. Most studies have found that depression is more common in those with left- side foci (Mendez et al 1999) suggesting a speciﬁc epileptic psycho syndrome (Lambert et al 1986) resulting from limbic dysfunction. A number of antiepileptic drugs have been implicated in the etiology of depression, especially barbiturates (Lambert et al 1986; Plioplys 2003). A chronic illness is in itself depressing and burdensome (Plioplys 2003). A number of factors contribute: the patient’s sense of having no control over seizures, the adverse effects of medication, the illness itself, resentment of a loss of independence seen in the need for life-long medication, fear that the stigma attached to epilepsy will interfere with social relationships, and anxiety about ﬁnances and medical insur- ance. Teenagers and adolescents are especially concerned with issues related to independence (Cramer 1994). Gender differences Although certain gender discrepancies exist in suicidal risk factors, gender seems to be an important factor in predicting suicide. A recent study (Kalinin et al 2005) of male gender showed that the suicidality grade depended on the presence of simple partial seizures (SPS), primary generalized seizures (PGS), secondary generalized seizures (SGS), and complex partial seizure (CPS). A high degree of the ﬁrst three sei- zures types determines a high degree of suicidality, while a large value for CPS implies, in contrast, a lower degree of suicidality. The presence of the above-mentioned seizure types could be a trigger factor in suicide attempt decisions. On the other hand, these seizure types could be connected to mental dete- rioration, itself a risk factor for suicide (Steinert et al 1994; Kalinin et al 2005). A large number of generalized tonic-clonic seizures is considered to be a risk factor for the development of cogni- tive impairment (Dodrill 1986; Aldenkamp 1997). Certain discrepancies exist between men and women with respect to the basic characteristics of epilepsy and suicide rate. A risk factor for suicide in men is a high frequency of SGS, SPS, and all types of seizures. As most partial seizures Neuropsychiatric Disease and Treatment 2008:4(2) Epilepsy and suicide have a temporal lobe origin, some authors concluded that temporal lobe epilepsy (TLE) in males represents a risk factor for suicidal behavior. Among female patients, in contrast, the presence of CPS is inversely correlated with death caused by suicide (Kalinin et al 2005). Early age epilepsy onset means a higher risk of suicide in men but not in women (Kalinin et al 2005). A different pattern of variables was obtained for females, consisting mostly of values of daily doses of certain anti-epileptic drugs (AEDs), that is, phenobarbital PHB, carbamazepine CBZ, valproate VPA, clonazepam CNZ. A high daily dose of PHB and high total number of all seizures would imply a higher degree of suicidality, while the other variables, including daily doses of different AEDs are more ambiguous and less useful for suicidality prediction in women. The prevalence of AED variables in the female gender can probably be explained by the behavioral toxicity of phe- nobarbitone (PHB) and lack of toxicity during treatment with carbamazepine (CBZ), valplroic acid (VPA), and clonazepam (CNZ). In addition, PHB is regarded as a depressogenic drug (Reijs et al 2004), and depression, in turn, could trigger suicidal attempts in women. A further study showed that daily doses of CBZ and VPA were negatively correlated with suicidal behavior especially in females who are more susceptible to depression: perhaps it could depend on their normotimic and antidepressive mode of action (Kalinin et al 2005). The development of new AEDs has occurred during the past few years, which are now available to treat all forms of epilepsy. Among these is topiramate (Kellett et al 1999), oxcarbazepine (Houtkooper et al 1987), gabapentin (Beydoun et al 1997), lamotrigine (Trenite et al 2001), and levetiracetam (Cramer et al 2000). Unfortunately little information is available on the psychiatric effects of these new AEDs, although probably lamotrigine’s antide- pressant action might suggest some advantages for its use (Critchley 1994). The risk of suicide in the presence of depression is ﬁve- fold higher in women and only twofold higher in men than in the general population (Kalinin et al 2005a, 2005b). Concomitant cognitive deterioration and personality traits or so-called “enechetic constitution” and “glishroidia” have also been shown to be signiﬁcantly related to suicidal risk (Ritaccio et al 2001). Within each gender the presence of cognitive deterioration increases suicide risk approximately ﬁvefold compared with the presence of depression. In other words, cognitive impairment is a much stronger risk factor for suicide than depression in both men and women, whereas 367