Received November 1, 2004; revised November 4, 2004; accepted December 4, 2004. From Thomas Jefferson Univ., Dept. of Psychiatry and Human Behavior, Philadelphia, PA (RM, SH, EJSK), and Newcastle, N. Tyneside and Northumberland NHS MH Trust, and the School of Neurology, Neurobiology, and Psychiatry, Univ. of Newcastle, Newcastleupon-Tyne, UK (NA). Send correspondence and reprint requests to Rajnish Mago, M.D., Thomas Jefferson Univ., Dept. of Psychiatry and Human Behavior, 833 Chestnut St. East, Suite 210 E, Philadelphia, PA 19107. e-mail: rajnish.mago@jefferson.edu Copyright 2006 The Academy of Psychosomatic Medicine Various psychiatric symptoms can occur in epilepsy or be induced by antiepileptic medications. Zonisamide is an antiepileptic medication used as adjunctive therapy for partial seizures. Depression, mania, obsessive-compulsive disorder, and psychotic symptoms have been reported in patients on zonisamide. According to the Physician’s Desk Reference, the most common psychiatric adverse effects of zonisamide are agitation (9%), depression (6%), insomnia (6%), anxiety (3%), nervousness (2%), and “schizophrenic behavior” (2%). Although a greater number of patients on zonisamide (1.1%) attempted suicide than those on placebo (0.4%), it was not clarified whether this was due to the induction of depression. We present here a case of sudden suicidal impulses without any concomitant depressive symptoms in a patient on zonisamide.