title: Antiepileptic drugs and suicide: a systematic review of adverse effects.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Fundació Institut Català de Farmacologia, Barcelona, Spain.
authors.forename: Pili
authors.initials: P
authors.lastname: Ferrer
authors.forename: Elena
authors.initials: E
authors.lastname: Ballarín
authors.forename: Mònica
authors.initials: M
authors.lastname: Sabaté
authors.forename: Xavier
authors.initials: X
authors.lastname: Vidal
authors.forename: Marietta
authors.initials: M
authors.lastname: Rottenkolber
authors.forename: Justyna
authors.initials: J
authors.lastname: Amelio
authors.forename: Joerg
authors.initials: J
authors.lastname: Hasford
authors.forename: Sven
authors.initials: S
authors.lastname: Schmiedl
authors.forename: Luisa
authors.initials: L
authors.lastname: Ibáñez
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D013405:Suicide
chemical_list: D000927:Anticonvulsants