Certain anticonvulsant drugs may be linked to an increased risk of suicidal acts or violent death, according to an analysis of prescriptions and insurance claims data by Boston researchers. The drugs, which are known to affect mood and behavior, are designed to prevent convulsions in patients with epilepsy. They are often prescribed for other conditions, including bipolar disorder, migraine, and neuropathic pain.
Dr. Elisabetta Patorno of Brigham and Women’s Hospital led a team that investigated the records of about 300,000 patients who were at least 15 years old when they were given anticonvulsants from 2001 through 2006. Their study, which appears in tomorrow’s Journal of the American Medical Association, follows a 2008 US Food and Drug Administration warning that several anticonvulsant medications might be linked to suicide, suicide attempts, and violent deaths. The federal action was based on a review that pooled 199 studies of 11 different drugs. Together they showed that patients taking them had twice the risk of suicidal thoughts compared with patients taking placebos.
The individual studies were not large enough to examine drugs separately, so the Boston researchers set out to evaluate the risk of suicidal acts and violent deaths associated with each of fifteen anticonvulsants compared to topiramate (Topamax) and carbamazepine (Tegretol), two commonly prescribed anticonvulsant drugs.
Over the course of their cohort study, there were 26 suicides, 801 attempted suicides, and 41 violent deaths among people starting anticonvulsant therapy. Compared with topiramate users, there were one and a half to two times more suicidal acts or violent deaths among users of gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), tiagabine (Gabitril), and valproate (Depacon). Compared with carbamazepine users, gabapentin users in subgroups of older and younger patients and patients with mood disorders also had about twice as many suicidal acts and violent deaths.
The results are compatible with the FDA’s analysis, the authors said.
“Clinicians should understand the benefits and risks of these particular medications on an individual patient basis,” Patorno said in an interview. “Patients should not stop taking their medications. They should discuss any type of concerns with their doctors and they should work together to find the best therapy.”
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Brigham Womens, Harvard University