Suicidality and epilepsy: A neuropsychobiological perspective

People with epilepsy (PWE) are at increased risk of experiencing suicidal ideation, displaying suicidal behavior, and committing suicide than the general population. The relationship between suicidality and epilepsy is complex and multifactorial in which operant pathogenic mechanisms include epilepsy-related variables, personal and familial psychiatric history, and iatrogenic effects. Furthermore, a bidirectional relationship between suicidality and epilepsy has suggested the existence of common neurobiological pathogenic mechanisms operant in both conditions and including disturbances of several neurotransmitters, in particular, serotonin (5HT), norepinephrine (NE), glutamate (GTE), and γ-aminobutyric acid (GABA), and disturbances of the hypothalamic–pituitary–adrenal axis (HPAA), which, in turn, can result in abnormal secretion of some of these neurotransmitters. The purpose of this article is to review these common neurobiological pathogenic mechanisms.

► The role of glutamate in depressive disorders has been well established. Whether glutamate is one of the common pathogenic mechanisms operant in depressive disorders, anxiety disorders, suicidality and epilepsy needs to be investigated, in particular with respect to the link of glutamatergic dysfunction with serotonergic mechanisms.
► The pathogenic role of inflamatory mechanims in epilepsy and depressive disorders have been suggested by several investigators and may constitute another potential pathogenic mechanism of these conditions. The degree to which a hyperactive HPAA plays a role will need to be investigated.
► Depression in pediatric patients remains an elusive disorder, as its clinical manifestations are often confused with behavioral disturbances. Consequently, depressive disorders remain under-recognized and untreated in this age group. The development of more sensitive and specific screening instruments to identify depressive disorders in children remains a challenge that needs to be met if we are ever to identify the children suffering from depressive disorders.