People with epilepsy have a higher risk for suicide than people without epilepsy. The relationship between seizure control and suicide is controversial. A standardized protocol to record history, diagnostic testing, and neuropsychiatric assessments was administered. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered presurgically and yearly for up to 5. years. Among the 396 enrolled, 4 of 27 deaths were attributed to suicide. The standardized mortality ratio, compared with suicides in the U.S. population and adjusted for age and gender, was 13.3 (95% CI. = 3.6-34.0). Only one patient had a BDI score suggestive of severe depression (BDI. = 33), one had depressive symptoms that did not the meet the depressive range (BDI. = 7), and the other two reported no depressive symptoms. Two of the patients reported moderate to severe anxiety symptoms (BAI. = 17 and 21, respectively). Suicide may occur after epilepsy surgery, even when patients report excellent seizure control.