R E V I E W Epilepsy and suicide: pathogenesis, risk factors, and prevention Alberto Verrotti1 Alessandra Cicconetti2 Barbara Scorrano2 Domenico De Berardis2,3 Carla Cotellessa2 Francesco Chiarelli1 Filippo Maria Ferro2 1Department of Pediatrics; 2Department of Oncology and Neuroscience, Institute of Psychiatry, University “G. d’Annunzio” of Chieti, Italy; 3Department of Mental Health, Teramo, Italy Correspondence:Alberto Verrotti Department of Pediatry, University “G d’Annunzio” of Chieti, Italy Tel +39 87 135 8015 Fax +39 87 157 4831 Email averrott@unich.it Abstract: Depression and suicide tendencies are common in chronic diseases, especially in epilepsy and diabetes. Suicide is one of the most important causes of death, and is usually underestimated. We have analyzed several studies that compare mortality as a result of suicide in epileptic patients and in the general population. All the studies show that epileptic patients have a stronger tendency toward suicide than healthy controls. Moreover it seems that some kinds of epilepsy have a higher risk for suicide (temporal-lobe epilepsy). Among the risk fac- tors are surgery therapy (suicide tendency ﬁve times higher than patients in pharmacological therapy), absence of seizures for a long time, especially after being very frequent, and psychiatric comorbidity (major depression, anxiety-depression disorders, personality disorders, substance abuse, psychoses). The aim of the review was to analyze the relationship between suicide and epilepsy, to identify the major risk factors, and to analyze effective treatment options. Keywords: epilepsy, suicide, depression Introduction Although clinicians and researchers have documented an association between epilepsy and psychiatric disorders for more than 30 years (Ott et al 2003), depression and other disorders remain underdiagnosed and undertreated in young people with epilepsy (Suris et al 1996; Plioplys 2003). One recent study of children of 5 to 16 years found that although about 60% of them had a Diagnostic and Statistical Manual of Mental Disorders IV (DSM) psychiatric diagnosis, only about 33% were receiving an appro- priate psychiatric treatment (Ott et al 2003). A paucity of published material has addressed the problem of suicide among epileptics. Studies on this topic have increased in recent years, but comparisons are difﬁcult because of the variety of study designs, different criteria, and different populations studied. This study’s principal aims were to discuss the epidemiological data on suicide among epileptics, to analyze in depth the possible risk factors of suicide behavior in epileptic patients, and to try and develop prevention strategies for this important issue. Epidemiological data Suicide is a rare event, occurring only slightly more than once among 10,000 persons annually in the United States (Goodwin and Jamison 1990; Murphy 1994). A high suicide rate among patients with epilepsy has been documented. A Danish study (Henriksen et al 1970) showed that 164 of 2763 patients with epilepsy died (an excess mortality rate of 273% compared with the expected number of deaths in Denmark); the case material included all adult epileptics. Although suicide is probably not a major cause of death among epileptics (Hauser et al 1980; Cockell et al 1994), a number of investigations have reported rates of death due to suicide among individuals with epilepsy. The percentage of deaths by suicide ranges from 1% to 33% with an Neuropsychiatric Disease and Treatment 2008:4(2) 365–370 © 2008 Verrotti et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 365