. 2023 Mar 14;100(11):e1123-e1134.

doi: 10.1212/WNL.0000000000201671. Epub 2022 Dec 20.

Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity

Andres M Kanner¹, Anita S Saporta², Dong H Kim², John J Barry², Hamada Altalib², Hope Omotola², Nathalie Jette², Terence J O'Brien², Siddhartha Nadkarni², Melodie R Winawer², Michael Sperling², Jacqueline A French², Bassel Abou-Khalil², Brian Alldredge², Martina Bebin², Gregory D Cascino², Andrew J Cole², Mark J Cook², Kamil Detyniecki², Orrin Devinsky², Dennis Dlugos², Edward Faught², David Ficker², Madeline Fields², Barry Gidal², Michael Gelfand², Simon Glynn², Jonathan J Halford², Sheryl Haut², Manu Hegde², Manisha G Holmes², Reetta Kalviainen², Joon Kang², Pavel Klein², Robert C Knowlton², Kaarkuzhali Krishnamurthy², Ruben Kuzniecky², Patrick Kwan², Daniel H Lowenstein², Lara Marcuse², Kimford J Meador², Scott Mintzer², Heath R Pardoe², Kristen Park², Patricia Penovich², Rani K Singh², Ernest Somerville², Charles A Szabo², Jerzy P Szaflarski², K Liu Lin Thio², Eugen Trinka², Jorge G Burneo²; Human Epilepsy Project

Affiliations

¹ From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine. a.kanner@med.miami.edu.
² From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine.

PMID: 36539302
PMCID: PMC10074468
DOI: 10.1212/WNL.0000000000201671

Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity

Andres M Kanner et al. Neurology. 2023.

. 2023 Mar 14;100(11):e1123-e1134.

doi: 10.1212/WNL.0000000000201671. Epub 2022 Dec 20.

Authors

Affiliations

¹ From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine. a.kanner@med.miami.edu.
² From the University of Miami (A.M.K., A.S.S., D.H.K.), Miller School of Medicine; Stanford University (J.J.B., K.J.M.), School of Medicine; Yale University (H.A., K.D.), School of Medicine; University of Texas in Houston (H.O.), School of Medicine; Icahan School of Medicine at Mount Sinai (N.J., M.F., L.M.); Monash University School of Medicine (T.J.O.B., Patrick Kwan); New York University (S.N., J.A.F., O.D., M.G.H., Ruben Kuzniecky, H.R.P.), Grossman School of Medicine; Columbia University (M.R.W.), College of Physicians and Surgeons; Thomas Jefferson University (M.S., S.M.), Sidney Kimmel Medical College; Vanderbilt University (B.A.-K.), School of Medicine; University of California San Francisco (B.A., M.H., R.C.K., D.H.L.), School of Medicine; University of Alabama in Birmingham (M.B., J.P.S.), School of Medicine; Mayo Clinic (G.D.C.), School of Medicine; Harvard Medical School (A.J.C.); University of Melbourne (M.J.C.), School of Medicine; University of Pennsylvania (D.D., M.G.), Pearlman School of Medicine; Emory University (E.F.), School of Medicine; University of Cincinnati (D.F.), School of Medicine; University of Wisconsin (B.G.), School of Medicine; University of Michigan (S.G.), School of Medicine; Medical University of South Carolina (J.J.H.); Albert Einstein School of Medicine (S.H.); University of Eastern Finland (Reetta Kalviainen), School of Medicine; Johns Hopkins School of Medicine (J.K.); Mid-Atlantic Epilepsy and Sleep Center (Pavel Klein); University of Colorado (K.P.), School of Medicine; Minnesota Epilepsy Group (P.P.); Carolinas Pediatric Neurology Care (R.K.S.); New South Wales Hospital (E.S.); University of Texas in San Antonio (C.A.S.), School of Medicine; Washington University in Saint Louis (K.L.L.T.), School of Medicine; Paracelsus Medical University (E.T.); and University of Western Ontario (J.G.B.), School of Medicine.

PMID: 36539302
PMCID: PMC10074468
DOI: 10.1212/WNL.0000000000201671

Erratum in

Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity.
Kanner AM, Saporta AS, Kim DH, Barry JJ, Altalib HH, Omotola H, Jette N, O'Brien TJ, Nadkarni S, Winawer MR, Sperling MR, French J, Abou-Khalil BW, Alldredge B, Bebin M, Cascino GD, Cole AJ, Cook MJ, Detyniecki K, Devinsky O, Dlugos DJ, Faught E, Ficker DM, Fields M, Gidal B, Gelfand M, Glynn S, Halford JJ, Haut S, Hegde M, Holmes MG, Kalviainen R, Kang J, Klein P, Knowlton RC, Krishnamurthy KB, Kuzniecky R, Kwan P, Lowenstein DH, Marcuse L, Meador KJ, Mintzer S, Pardoe HR, Park KL, Penovich P, Singh RK, Somerville E, Szabo CA, Szaflarski JP, Thio LL, Trinka E, Burneo JG. Kanner AM, et al. Neurology. 2025 Oct 21;105(8):e213520. doi: 10.1212/WNL.0000000000213520. Epub 2025 Sep 22. Neurology. 2025. PMID: 40982776 Free PMC article. No abstract available.

Abstract

Background and objectives: Mood, anxiety disorders, and suicidality are more frequent in people with epilepsy than in the general population. Yet, their prevalence and the types of mood and anxiety disorders associated with suicidality at the time of the epilepsy diagnosis are not established. We sought to answer these questions in patients with newly diagnosed focal epilepsy and to assess their association with suicidal ideation and attempts.

Methods: The data were derived from the Human Epilepsy Project study. A total of 347 consecutive adults aged 18-60 years with newly diagnosed focal epilepsy were enrolled within 4 months of starting treatment. The types of mood and anxiety disorders were identified with the Mini International Neuropsychiatric Interview, whereas suicidal ideation (lifetime, current, active, and passive) and suicidal attempts (lifetime and current) were established with the Columbia Suicidality Severity Rating Scale (CSSRS). Statistical analyses included the t test, χ² statistics, and logistic regression analyses.

Results: A total of 151 (43.5%) patients had a psychiatric diagnosis; 134 (38.6%) met the criteria for a mood and/or anxiety disorder, and 75 (21.6%) reported suicidal ideation with or without attempts. Mood (23.6%) and anxiety (27.4%) disorders had comparable prevalence rates, whereas both disorders occurred together in 43 patients (12.4%). Major depressive disorders (MDDs) had a slightly higher prevalence than bipolar disorders (BPDs) (9.5% vs 6.9%, respectively). Explanatory variables of suicidality included MDD, BPD, panic disorders, and agoraphobia, with BPD and panic disorders being the strongest variables, particularly for active suicidal ideation and suicidal attempts.

Discussion: In patients with newly diagnosed focal epilepsy, the prevalence of mood, anxiety disorders, and suicidality is higher than in the general population and comparable to those of patients with established epilepsy. Their recognition at the time of the initial epilepsy evaluation is of the essence.

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Conflict of interest statement

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

Comment in

Suicidality in Epilepsy: Common With Various Mood and Anxiety Disorders.
Munger Clary H, Gilliam F. Munger Clary H, et al. Neurology. 2023 Mar 14;100(11):499-500. doi: 10.1212/WNL.0000000000206839. Epub 2022 Dec 20. Neurology. 2023. PMID: 36539300 No abstract available.

References

1. Abraham N, Buvanaswari P, Rathakrishnan R, et al. A meta-analysis of the rates of suicide ideation, attempts and deaths in people with epilepsy. Int J Environ Res Public Health 2019;16(8). - PMC - PubMed
1. Pompili M, Girardi P, Ruberto A, Tatarelli R. Suicide in the epilepsies: a meta-analytic investigation of 29 cohorts Epilepsy Behav. 2005;7(2):305-310. - PubMed
1. Eliasen A, Dalhoff KP, Horwitz H. Neurological diseases and risk of suicide attempt: a case-control study. J Neurol. 2018;265(6):1303-1309. - PubMed
1. Jones JE, Hermann BP, Barry JJ, Gilliam FG, Kanner AM, Meador KJ. Rates and risk factors for suicide, suicidal ideation, and suicide attempts in chronic epilepsy. Epilepsy Behav. 2003;4:31-38. - PubMed
1. Hecimovic H, Santos JM, Carter J, et al. Depression but not seizure factors or quality of life predicts suicidality in epilepsy. Epilepsy Behav. 2012;24:426-429. - PMC - PubMed

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Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity

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Mood and Anxiety Disorders and Suicidality in Patients With Newly Diagnosed Focal Epilepsy: An Analysis of a Complex Comorbidity

Authors

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Erratum in

Abstract

Conflict of interest statement

Comment in

References

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