Some Anticonvulsant Drugs Are Linked to Increased Suicide Risk

A new study at Brigham and Women's Hospital in Boston has found that some drugs used to treat epilepsy, depression, bipolar disorder, migraines, chronic pain, and other disorders may be linked to a higher risk of suicide or violent death than other drugs in the same class. The study analyzed data from nearly 300,000 people aged 15 or older who had taken an anticonvulsant and the rates of suicides, suicide attempts, or violent deaths during the first 60 days patients took the drugs.

A 2008 review of 11 anticonvulsant drugs by the Food and Drug Administration (FDA) showed roughly double the risk of suicidal thoughts and suicide attempts for patients taking the drugs versus the risk for patients taking placebos. Although the absolute risk of suicide remained small, less than one half of one percent, the FDA mandated that all drugs in this class carry a warning about the increased risk.

The new study at Brigham and Women's Hospital looked at 13 anticonvulsant drugs commonly prescribed as part of health plans across the country. This new study went a step further than the FDA review by analyzing individual drugs in the anticonvulsant class. They compared the number of attempted suicides, suicides, and violent deaths reported for users of each individual drug compared to the number of incidents reported for topiramate (Topamax). Topamax is one of the most frequently prescribed anticonvulsant drugs for a range of different conditions.

Of the 12 anticonvulsant drugs compared with Topomax, 5 were found to increase the risk of suicidal behavior. The 5 drugs, gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), tiagabine (Gabitril), and valproate (Depakote), treat a variety of conditions and work differently.

Although the study allowed for such conditions as patients' varied diagnoses and overall health, critics believe the study may have some limitations. They point out that many patients in the study suffer from a variety of disorders that carry an inherent increased risk of suicide. Critics also point out that the control drug Topomax is known to worsen some psychiatric conditions so doctors do not prescribe it as often for patients with any personal or family history of mental illness. Topomax, therefore, may be less likely to have suicidal and violent deaths linked to its use.

Critics also cited the lack of studying patients over time, pointing out that there is an increased suicide risk for patients newly diagnosed with these illnesses regardless of what medications they are prescribed. In addition, because this study relied on insurance billing codes for a patient's diagnosis, the data for patients with multiple diagnoses may not have been properly analyzed.

The study does not recommend that patients stop taking these medications. A patient should never stop taking this type of medication without a thorough consultation with their physician. It is important to discuss with your doctor any mental health issues in your personal or family history and immediately report any feelings of depression or suicidal or violent thoughts you experience while taking these or any medications.

The increasing number of prescriptions written for this class of drugs for a variety of conditions makes it imperative for doctors to ask the critical mental health history questions. Good communication between physician and patient can mitigate the risk of these and other drugs. For most patients the medical benefits of taking the drugs far still outweigh the risks, and a good patient-physician relationship can further reduce the risk.

Source:

http://www.cnn.com/2010/HEALTH/04/13/depression.drugs.suicide.risk