Abstracts

Rationale: The 2008 FDA alert concerning suicidality and antiepileptic drugs (AED) has prompted epilepsy care centers to assess related clinical practices. We previously reported on a new process for monitoring depression (DEP) and suicidal symptoms for our adult patients in a busy epilepsy clinic. The purpose of the current project is to extend these data by describing any association between general and specific AED use and patient self-report of clinical DEP and suicidal ideation (SI).Methods: All adult (18+) patients seen at the Minnesota Epilepsy Group clinic for first-time or routine clinic visits were administered a brief self-report questionnaire if they were their own legal guardian and able to read and understand the questionnaire. The questionnaire included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and the suicide question from the Beck Depression Inventory-II (BDI-II). Patients were also asked if they were being treated by a psychiatrist or psychologist/counselor. Current AED and other psychotropic drug data were collected from each patient. Clinical staff (i.e., nurse and/or physician) scored the screening measure and took action based on the level of DEP and/or SI symptoms.Results: 1,170 screening questionnaires were completed over the course of one year with 57% of the respondents being female, 43% male. 17% (n = 197) of the sample scored in the clinical DEP range (> 15) on the NDDI-E and 9% (n = 101) indicated some level of SI on the BDI-II. Only 5% of the sample were not prescribed AEDs while 45%, 32%, and 18% were taking 1, 2, and 3+ AEDs, respectively. 26% of the sample were prescribed psychotropic medication. 14% and 10% of the sample reported currently seeing a psychiatrist or psychologist/counselor, respectively. No statistically significant association was found between any AED use and clinical DEP or SI. A subset of AEDs: LTG (n = 460), VPA (n = 141), PHT (n = 55), PHB (n = 22), TPM (n = 137), CBZ (n = 130), FBM (n = 94), GBP (n = 34), ZNS (n = 89), OXC (n = 66), LEV (n = 503), and LAC (n = 93) were then evaluated for association with self-reported clinical DEP or SI and all were found to be non-significant except for LAC (p =.03 for DEP & p = .007 for SI). Conclusions: Using a new process to monitor depression and suicidal symptoms in a busy epilepsy clinic, we found little evidence that general AED use is associated with clinical DEP symptoms or SI. More specific analyses with individual AEDs revealed that only persons prescribed lacosamide showed a statistically significant higher rate of both clinical DEP symptoms and SI. Further evaluation of this particular group is necessary to delineate the meaning of this finding.