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Suicidality, depression screening, and antiepileptic drugs

Reaction to the FDA alert

From the Department of Neurology, The Ohio State University, Columbus.

Address correspondence and reprint requests to Dr. Bassel F. Shneker, Department of Neurology, Ohio State University, 7th Floor, 395 West 12th Avenue, Columbus, OH 43210 shneker.1{at}osu.edu

Objective: To determine the reaction of neurology practitioners to the Food and Drug Administration (FDA) alert concerning suicidality (suicidal ideation or behavior) and antiepileptic drugs.

Methods: We designed a 21-question survey asking about the participants’ approach to suicidality and depression in patients with epilepsy (PWE), and their reaction to the FDA alert and its impact on their clinical practices. Participants (n = 780) were invited via e-mail to respond to a Zoomerang survey. Two reminders were sent to increase the response.

Results: The survey was completed by 175 participants (22%). Most were epilepsy specialists practicing in academic settings. Almost 62% did not use any scale to routinely screen for depression in PWE. For those who used a scale, the Beck Depression Inventory was the most used one. About 42% did not feel comfortable initiating treatment for depression. Although 98% warn about behavioral side effects when starting antiepileptic drugs, only 44% warn specifically about suicidal ideations or behavior. More than half were not aware of patients who attempted to commit suicide or who had committed suicide. The mean scores for the FDA alert clarity, appropriateness, and impact on clinical practice (on a scale from 1 to 10) were low, at 5.3, 4.1, and 3.6. Almost 46% did not feel the alert is going to change their practice.

Conclusion: The Food and Drug Administration alert did not get a favorable score from the surveyed responders. Participants actively alert patients about behavioral side effects of antiepileptic drugs, but are not specific about suicide.

AED = antiepileptic drug; AES = American Epilepsy Society; BDI = Beck Depression Inventory; FDA = Food and Drug Administration; HAM-D = Hamilton Depression Rating Scale; NDDI-E = Neurological Disorders Depression Inventory for Epilepsy; PWE = patients with epilepsy; SD = standard deviation.

Disclosure: The authors report no disclosures.

Received November 3, 2008. Accepted in final form December 30, 2008.

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