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Some anticonvulsant drugs increase suicide risk

April 13, 2010 |  1:00 pm

Two years ago, the U.S. Food and Drug Administration published information showing that people taking anticonvulsant medications, drugs used to treat epilepsy, have twice the risk of suicidal behavior and suicidal thoughts. A study published Tuesday in the Journal of the American Medical Assn. confirms that finding and identifies a handful of medications that appear to carry the most risk.

Researchers led by a team from Brigham and Women's Hospital in Boston, analyzed data from almost 300,000 people who had begun taking an anticonvulsant. They recorded reports of suicide, attempted suicide or violent deaths in the first 60 days of use. The patients were ages 15 or older. The study found an increased risk of suicidal acts and violent deaths for the drugs gabapentin, lamotrigine, oxcarbazepine, tiagabine and valproate when compared with a standard anticonvulsant, topiramate. For example, there were 5.6 cases of attempted or completed suicide per 1,000 person-years among gabapentin users, 10 cases per 1,000 person-years among oxcarbazepine users and 14.1 cases per 1,000 person-year among tiagabine users compared with topiramate users. The increased risk began about 14 days after the start of treatment.

No one knows why certain anticonvulsants increase the risk of suicidal behavior, however, they are known to produce mood and behavior changes. The FDA requires anticonvulsant drug products to carry a label with information about the suicide risk. Perhaps a stronger warning, such as black box warning on the medication, is warranted. Certain anticonvulsants such as gabapentin have soared in popularity in recent years, often used off-label for psychiatric disorders and various pain conditions. The drugs may be effective to treat disorders other than epilepsy, but they are not without risk.

-- Shari Roan

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Comments (2)

I was recently prescbibed gabapentin for diabetic nueropathy and have had numerous artistic passions revived by the drug. It works for the nerve pain and depression as well.
It's also a great sleep aid. I've only been taking it for a couple of weeks and the doctor said it takes about 5 weeks for the full effects to kick in! I'll watch for negative side effects but right now I know a lot of people who could benefit from this medication.

This article demonstrates the difference between impressionistic statistics and informed/controlled scientific, statistical analysis. The problem is that there is no mention of the diagnoses for which the various anti-epilepsy drugs (AED's) were prescribed. People with a Bipolar Disorder have a much higher suicide and violent death rate than people with seizure disorders (the highest of all psychiatric diagnoses). Chronic pain disorders are also known to cause increased suicidality. Hence, prescription of any medication for people in these diagnostic categories will be associated with increased suicide and violent death rates both with and without treatment.
Additionally, Gabapentin, while not a great mood stabilizer, has been used quite effectively in controlling the intensity of anxiety seen with withdrawal and early recovery from serious substance or alcohol abuse. This diagnostic group also has a higher than usual death rate.
Finally, for reasons that are not entirely clear, Trileptal (Oxcarbazepine) has enjoyed a long run of over prescription in the face of minimal supportive evidence of efficacy and without FDA approval (indication) for the treatment of Bipolar Disorder. In other words, people are treating the most lethal psychiatric illness (in absolute numbers) with one of the most ineffective medicines known. Not surprisingly, increased death rates should be expected.
Fortunately, Topiramate, despite a brief flurry of off-label prescription for Bipolar Disorder a few years ago, is now prescribed mostly for the FDA approved indications of seizure disorders and migraines. Consequently, the population that receives Topiramate is not at a markedly increased risk for suicidal or violent death, thereby reflecting a reduced death rate from those causes.
In conclusion, statistics don't lie but statisticians do. More charitably put, poorly designed studies with less than complete adjustments for possible confounders will inevitably lead to peculiar and inadequate (incorrect) conclusions.
John Cowl, MD Distinguished Life Fellow of the American Psychiatric Association



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