Managing Suicidal Ideation in Patients with Epilepsy

By: Brooke McBay

Suicide. The word itself elicits many feelings from those who read it. Despite this, there is a profound difficulty in discussing its prevalence or the populations in which it becomes endemic. Many struggle in silence, often leading to a preventable action that plagues millions worldwide. Although, it is notable how these numbers are much higher among the chronically ill, notably those with epilepsy. A study conducted from 2003 to 2011 found that individuals with epilepsy (16.89/per 100,000 persons) are 22% more likely than the average population (13.84/per 100,000 persons) in the same states and years to commit suicide (Tian et al., 2016). Research has supported that epilepsy, psychiatric disorders, and suicide are pathophysiologically linked (Tian et al., 2016). The Food and Drug Administration asserted there is an increased risk of suicide for people taking antiepileptic drugs (AEDs), thereby requiring standardized assessment of suicidality at regular intervals during follow-ups in future AED clinical trials (Mula & Hesdorffer, 2011). The connection between epilepsy and suicidality poses the importance of mental health screenings for individuals diagnosed with epilepsy, especially in individuals who range around 40-49 years old (Tian et al., 2016). Suicide is a public health concern that we as a community need to address. Conversations around suicide can undoubtedly be uncomfortable, but these conversations can be the difference between life and death. Since suicide is mainly preventable, we must be educated on managing a crisis if we encounter someone contemplating suicide. 

Suicide is considered one of the most significant issues plaguing the epileptic community (Nilsson, Ahlbom, Farahmand, Åsberg, & Tomson, 2002). Also, it is crucial to acknowledge how extenuating circumstances may contribute to suicide. The recent economic crisis, pandemic, job insecurity, and health concerns may have led to the increased unemployment, poverty, and debt  (Tian et al., 2016). These factors could contribute to an increase in mental illness, such as depression, which is a significant risk factor for suicide. Research has shown that depression is believed to impact 30-50% of individuals with epilepsy (Swinkels, Kuyk, van Dyck, & Spinhoven, 2005). Therefore, we must acknowledge these extenuating factors to better understand suicidal ideations in patients with epilepsy. Seeing that epilepsy is largely stigmatized in society, it is important to note these individuals may already be struggling to find the resources or social support that they need. We must reaffirm the stories and experiences of those we encounter to create safe spaces to facilitate such important conversations. 

First, let’s decipher the difference between the phrasing about suicide. A suicide attempt is when an individual tries to take their own life but is unsuccessful. Suicidal Ideations are thoughts of committing suicide or self-harm. Suicide is death caused by oneself. There can be many reasons why an individual may be contemplating suicide, so it helps to talk with the person. You must come from a non-judgmental stance and express support, empathy, and kindness when necessary. Research suggests that individuals with epilepsy were more likely to poison themselves, most commonly with their antiepileptic drugs, than those without epilepsy (Tian et al., 2016). Thus, individuals with epilepsy would benefit from having caregivers, family members, friends, and others to monitor harmful materials to prevent suicide (Tian et al., 2016). Supervision is especially crucial at home as most suicides reported in individuals with epilepsy occurred most commonly at home and expressed previous intent (Tian et al., 2016).

Here are steps to help the patient: 

1. Assess for safety, lessen the potential for harm and decide whether health and safety professionals need to be called 
   1. If necessary, do not leave them alone until help arrives 
2. Ask the patient if they are contemplating suicide 
   1. Asking the person if they are thinking about suicide does not make them more willing to end their life
3. Ask the person if they have someone they can speak to about these feelings? Assess for potential support systems. 
4. Direct them to a licensed professional to manage this crisis or seek aid from a crisis helpline 
5. Helping someone contemplating suicide can be very impactful; it may be helpful to get help or speak to someone else. 
   1. Resources are listed below 

Helpful Phrases	Unhelpful Phrases.
How can I help you?	You are overreacting.
I am here for you, and you are not alone.	It is all in your head.
Are you thinking about suicide?	What do you have to be sad about?
Has this happened before? If so, how did you manage it?	Get over it.
Do you have someone we can call?	Downplaying the significance
What are things that can help you feel better?	Belittling their experience

Education is essential in ensuring we have the tools available to help others. Listed below are helpful resources that may help you or someone in need. 

• National Suicide Prevention Lifeline 
  • Call 1-800-273-TALK (8255)
  • Online Lifeline Crisis Chat 
• Veterans Crisis Line 
  • Send a text to 838255
• SAMHSA Treatment Referral Hotline (Substance Abuse) 
  • 1-800-622- HELP (4357)
• RAINN National Sexual Assault Hotline 
  • 1-866-331-9474
• The Trevor Project 
  • 1-866-488-7386
• Suicide Safe
  • US Substance Abuse and Mental Health Service Administration’s Suicide prevention app 
• Mental Health First Aid 
• Meet with your primary care provider, local walk-in clinic, emergency department or urgent care
• Stay involved in local, statewide and federal policy that may affect these resources
• See more Suicide Prevention Resources at the American Foundation for Suicide Prevention 

Know that you are never alone. There is no shame in asking for help. We are strong, and together, we can defeat epilepsy. To learn more and get involved, see more on www.defeatingepilepsy.org 

Resources

Mula, M., & Hesdorffer, D. C. (2011). Suicidal behavior and antiepileptic drugs in epilepsy: analysis of the emerging evidence. Drug, healthcare and patient safety, 3, 15–20. https://doi.org/10.2147/DHPS.S13070

Nilsson, L., Ahlbom, A., Farahmand, B., Åsberg, M., and Tomson, T. (2002), Risk Factors for Suicide in Epilepsy: A Case Control Study. Epilepsia, 43: 644-651. https://doi.org/10.1046/j.1528-1157.2002.40001.x

​​Tian, N., Cui, W., Zack, M., Kobau, R., Fowler, K. A., & Hesdorffer, D. C. (2016). Suicide among people with epilepsy: A population-based analysis of data from the U.S. National Violent Death Reporting System, 17 states, 2003-2011. Epilepsy & behavior: E&B, 61, 210–217. https://doi.org/10.1016/j.yebeh.2016.05.028

Swinkels, W. A., Kuyk, J., van Dyck, R., & Spinhoven, P. (2005). Psychiatric comorbidity in epilepsy. Epilepsy & behavior: E&B, 7(1), 37–50. https://doi.org/10.1016/j.yebeh.2005.04.012