Epilepsy, Suicidal Ideation and Their Complex Relationship: Apropos of A Clinical Case

People with epilepsy are at an increased risk of suicide and suicidality (suicidal ideation or behavior), typically with a standardized mortality ratio between 3 and 5, making it a significant cause of premature death. Recent years have seen the recognition of suicidality as a potential complication of several drug groups, including antiepileptic drugs (AEDs). Managing cases of suicidality in patients without a psychiatric history, where the initiation of an AED is the only new factor, poses a particular challenge. Aim: The authors report the case of a man with no psychiatric history who developed suicidal thoughts after starting eslicarbazepine for post-traumatic brain injury epileptic seizures. Methods: The patient was monitored after starting eslicarbazepine, with regular psychiatric evaluations for mood, anxiety, and suicidal ideation. Despite suspected medication-induced suicidal thoughts, treatment continued, supplemented by anxiolytics and mood stabilizers. Collaboration with neurology ensured a comprehensive care approach. Results: A decision was made to switch the antiepileptic to topiramate, in collaboration with the neurology team. Following this change, a significant improvement in the patient's mental health was observed, with a marked reduction in suicidal thoughts and stabilization of mood. The patient’s anxiety levels also decreased, contributing to overall better clinical outcomes. Conclusion: This case highlights the importance of careful monitoring for suicidality in patients receiving AEDs, even in the absence of psychiatric history. Prompt recognition and appropriate intervention, including potential medication adjustments and additional support for anxiety and mood stabilization, were crucial. Psychiatry-Neurology collaboration improved outcomes, integrating pharmacological, neurological and psychological factors.