How does antiepileptic drug induce suicidality? A case associated with levitracetam use.
New antiepileptic drugs have been known to increase the risk of suicide. Among them, levitracetam is a widely used antiepileptic drug approved as a monotherapy treatment for partial seizures or as an adjunctive therapy for partial, myoclonic and generalized tonic-clonic seizures. It has been reported that the incidence of suicidal ideation during treatment with levitracetam was about 0.5-0.7%, but an explanation regarding a mechanism by which it causes suicidality is lacking. We made a multifaceted approach using the Hamilton Depression Rating Score (HDRS), the Hamilton Anxiety Rating Score (HARS), the Beck Hopelessness Scale (BHS), the Barratt Impulsiveness Scale (BIS), the Beck Scale for Suicidal Ideation (BSS) ideation daily and the Sheehan Suicidality Tracking Scale (SSTS) weekly in a patient taking levitracetam who acutely developed suicidal ideation after starting the medication. Suicidal ideation disappeared within 5 days of levitracetam discontinuation. We found that decreasing HDRS and BHS scores were correlated with BSS and SSTS scores. On the other hand, HARS and BIS did not change from their baselines. Our findings suggest that suicidality induced by an antiepileptic drug may be related to depression rather than anxiety and impulsiveness.
Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea.
Hoo Rim
HR
Song
Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea.
Young Sup
YS
Woo
Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea.
Hee-Ryung
HR
Wang
Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea.
Tae-Youn
TY
Jun
Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 150-713, Korea. Electronic address: wmbahk@catholic.ac.kr.
Won-Myong
WM
Bahk
D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012640:Seizures / Q000188:drug therapy* / Q000523:psychology; D059020:Suicidal Ideation
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
Antiepileptic drug; Levitracetam; Suicide