Recommendations for Addressing Suicidal Ideation Precipitated by Levetiracetam in the Treatment of Seizure Disorder: A Case Report and Review of the Literature

Abstract

Suicidal ideation with levetiracetam is a relatively common occurrence in psychiatry and neurology practices. However, there are no established treatment guidelines, and more empirical evidence is needed to guide medical management in these cases. This report describes the case of a 17-year-old male patient with a history of poorly controlled epilepsy on oxcarbazepine who developed worsening anxiety after the initiation of levetiracetam and presented with suicidal ideation for the past three weeks; this was effectively managed with comprehensive care in our inpatient psychiatric center, resulting in the resolution of these thoughts. To support this case, we conducted a literature review using MEDLINE (Medical Literature Analysis and Retrieval System Online), PubMed, and Google Scholar to explore existing treatment protocols for patients experiencing suicidal ideation related to levetiracetam. This study proposes a treatment protocol, presented as a flowchart, that outlines various treatment modalities based on assessed risk factors in patients with suicidality associated with levetiracetam. We conclude that establishing a psychiatric treatment protocol will enable providers to effectively manage an amenable risk factor of suicidality. There is a need for further evidence-based research studies to strengthen our proposed treatment protocol.

Keywords: anti epileptics; levetiracetam; psychiatric disorders; recommendation; self-harm; suicidal ideation.

Figure 1. Treatment protocol in patients with suicidality associated with levetiracetam.

SDQ: Strengths and Difficulties Questionnaire; SSI: Scale for Suicidal Ideation; CDI: Children’s Depression Inventory; QOLIE: Quality of Life in Epilepsy; CSSRS: Columbia Suicide Severity Rating Scale; ASQ: Ask Suicide-Screening Question; AED: antiepileptic drug; SSRI: selective serotonin reuptake inhibitors; CBT: cognitive behavioural therapy; PST: problem-solving therapy; SI: suicidal ideation; LEV: levetiracetam Mood stabilizing AEDs: valproate, lamotrigine, and oxcarbazepine