Drug overdose and suicide in Epilepsy

One of the most devastating piece of news physicians can get is that one of our familiar patients has died, not of natural causes or the pathological progression of a disease, but due to suicide. The correct treatment of Epilepsy requires a longstanding relationship with the patients and their families, trying to seek a seizure-free environment so they can have a fruitful, enjoyable lifestyle. Unfortunately, too much attention is being given to medication and little to depression and anxiety.

Dr. Harley C. Gorton directed a study in the United Kingdom that canvassed two large primary care-data sets, the Clinical Practice Research Datalink (CPRD) in England and the Secure Anonymized Information Linkage (SAIL) Databank in Wales, in order to detect unnatural deaths in epileptic patients. Oftentimes the certificate of death of patients do not list Epilepsy as a contributing factor, which severely limits the study of that condition’s morbidity and mortality. Those two databases are linked to hospitalization, outpatient care centers and death records. This study suggested that physicians should pay more attention to co-morbid conditions like anxiety, depression and substance abuse, plus monitor the use of opioids and psychotropic medication.

In this study the researchers matched 44,678 participants with Epilepsy in the CPRD database to 891,429 participants without it in a period spanning from 1998 to 2014; they matched 14,051 participants with the disease in the SAIL database to 279,365 people from 2001 to 2014. Epileptic patients were 2.77 times more likely to die of an unnatural cause, 2.97 times more likely to die of unintentional injury or poisoning, and 2.15 times as likely to die of suicide. People taking medication had 4.99 times higher risk of collateral effects and 3.55 times higher risk of misuse. The most widely abused medication were opioids (56.5%) and psychotropic agents (32.3%)

The researchers stated that “patients should be adequately advised about unintentional injury prevention and monitored for suicidal ideation, thoughts and behavior.” They also said that “the suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.” The care personnel should understand that “good seizure control” is not limited to just a proper medication schedule to obtain a good quality of life for the patients. An excessive focus on seizure control in the follow-up of epileptic patients will sideline the necessary screening for psychiatric and behavioral health issues with the timely referral to other specialists.

It is extremely uncomfortable to discuss the issue of “mental health” with our patients and their families in our medical offices, especially because an archaic stigma lingers on in our societies. However, we must start the discussion in a respectful way, without alarming them excessively; we must stress out that we want to offer them information, without suggesting any particular venue. Sometimes epileptic patients have difficulties to access the mental health care services because the payors will not cover the expenditures, or they lack the proper information due to a disconnect. Our personal attitudes towards these patients must include a greater dosage of sympathy for them.

Suicide Prevention Hotline 1-888-628-9454/ www.suicidepreventionlifeline.org

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Don’t leave me alone.