Suicide and epilepsy: do antiepileptic drugs increase the risk?

INTRODUCTION: Years after the US FDA issued an alert on an increased risk of suicide ideation and behavior in people with epilepsy treated with antiepileptic drugs (AEDs), this issue still remains controversial. The FDA alert was based on a meta-analysis of clinical trials of AEDs in all indications. AREAS COVERED: We discuss major methodological problems of this meta-analysis. Available evidence coming from the published studies is also discussed highlighting that the majority of them are also affected by major methodological limitations, which do not allow an absolute conclusion. EXPERT OPINION: Suicide in epilepsy is a complex phenomenon but most agree that suicide rates are higher in people with epilepsy when compared to the general population. Screening for suicide seems to be appropriate and well-designed prospective studies are urgently needed in order to clarify fully a possible role of AEDs.