Managing Suicidality in Patients with Neurologic Disease (Podcast)

Suicidal thoughts appear to be more prevalent in patients with neurologic disease than in the general population. Studies have reported suicidal ideation in 25% to 40% of these patients, depending on the condition, screening tool and other factors.

“Patients with epilepsy or movement disorders, for example, sometimes think their depression symptoms will improve when their neurologic condition improves,” says Tatiana Falcone, MD, a psychiatrist in Cleveland Clinic’s Epilepsy Center. “But that’s not always true. Unless you treat both the neurologic condition and the mood disorder, the mood disorder continues to progress. The longer it progresses, the higher the probability of suicidal thoughts and suicide attempts.”

Dr. Falcone explains more about the overlap of suicide and neurologic disorders in the newest episode of Cleveland Clinic’s Neuro Pathways podcast. Topics she touches on include:

• Causes of increased suicidality in patients with neurologic conditions
• Screening for mood disorders
• Tips for addressing patients with increased suicide risk
• Medications to treat mood disorders — and the one that shouldn’t be used in patients with epilepsy
• How to respond to patients concerned about increased suicidality as an adverse effect of anti-epileptic medications

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Falcone: We did a study recently, published in Epilepsia in December, that looked at conversations about suicide had by adults with epilepsy versus children with epilepsy. One of the things we saw is that there are two different stages. In the adult population, we saw a lot of hopelessness. Epilepsy’s impact on their ability to work and do other things contributed to having suicidal thoughts. In kids, it was the unknown. They didn’t understand how to make their epilepsy better.

Sometimes parents try to protect their kids, not including them in the regular conversations about their care. But it’s very important to include them because when you don’t, kids get more worried about what’s happening. They need to understand what’s happening.

In adults, we saw that hopelessness was something major. So, it’s important to make sure that every time someone leaves your office after an appointment, they have hope. You don’t want to finish your appointment when someone is crying and feeling really bad about what’s going on. You have to try to make sure that they understand what other possibilities there are and where they can go from here. That can be helpful.