Suicidality in epileptics on levetiracetam therapy with preceding comorbidity

Anti-epileptic medications like levetiracetam, sodium valproate, topiramate and lamotrigine are known to produce serious adverse reactions like suicidal tendencies, Steven Johnson syndrome, toxic epidermal necrolysis, hepatic dysfunction, pacreatitis, depression and psychotic episodes. Here we report two patients who attempted suicide, had psychiatric comorbidity and alcoholism and were on treatment. One patient died and the other was treated for poisoning and survived. Both the patients were on levetiracetam. It is assumed that levetiracetam could have contributed to the suicidal ideation as an adverse reaction. SUDEP (sudden unexplained death in epilepsy) might as well be considered in the second patient. It is suggested that patients on newer anti epileptics be screened for suicidal intent and treated for psychiatric comorbidity like depression. One of the patients had alcoholism and the other comorbid depression.