Drugs that treat epilepsy, depression linked to suicide
Some antiseizure drugs used to treat epilepsy as well as depression, chronic pain, migraine, bipolar disorder, and other conditions are.
(The researchers did not track suicidal thoughts, as did many of the trials considered by the FDA.). Of more than 2 million prescriptions filled in the five-year study period, the researchers looked at 297,620 new prescriptions. Among people who received the drugs, there were 801 suicide attempts, 26 suicides, and 41 violent deaths.
Kanner also notes that health conditions such as depression and epilepsy, which sometimes overlap, can combine to affect suicide risk in ways that may have eluded the researchers' models. "You're dealing with a very complex interaction," he says. "To just attribute to antiepileptic medication doesn't explain the facts properly.". Dr.
The risk of completed or attempted suicide was also higher among people taking lamotrigine, valproate, or gabapentin, compared to topiramate. The risk of completed or attempted suicide among people taking tiagabine was 2.5 times greater than it was among those taking topiramate, while the risk among people taking oxcarbazepine was twice as great, the study found.
Kanner says. For one thing, he explains, topiramate -- which is most commonly prescribed for migraine -- is known to worsen some psychiatric conditions and many doctors won't prescribe it to patients with a personal or family history of mental illness. But the study has some important limitations, Dr.
"Very often clinicians will not inquire about these issues, and that's where things get lost," he says. Kanner emphasizes that patients who are currently taking the drugs for any reason should not stop taking them without consulting their doctor, and that patients should also l their doctor if they have a history of mental illness or if it runs in their family. Dr.
"In my mind, you have to keep it in perspective. "The main thing is to be cautious about the risks versus the benefits," he says. There may be an increased risk of suicidal ideation, most of these patients have tremendous benefits from the drugs.".
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In all, 5 of the 12 drugs compared with topiramate were found to increase the risk of suicidal behavior.
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Bazil, but patients should not be overly alarmed by the study. People taking the drugs should l their doctor if they begin to feel depressed, or have thoughts of suicide, says Dr.
Pinpointing whether anticonvulsants boost suicide risk in and of themselves will likely require a study that follows people over time, rather than one that looks back at previous treatment, as the current investigation did, Dr. Kanner adds.
( Health.com ) -- Some antiseizure drugs used to treat epilepsy as well as depression, chronic pain, migraine, bipolar disorder, and other conditions are associated with a higher risk of suicide and violent death than other drugs in the same class, according to a new study.
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According to the FDA analysis, which included 11 anticonvulsants, the risk that a person taking those drugs would exhibit suicidal behavior or have suicidal thoughts was about 1 in 230, compared to about 1 in 450 in people taking a placebo, the FDA found.
Doctors are increasingly prescribing the drugs off-label, meaning the drugs are not officially approved by the FDA for that condition. The use of anticonvulsants has risen in recent years, among adults as well as children and teens.
"The vast majority of patients do not have anything like that." Dr. Bazil was not involved in the research.
Because having a mental illness such as bipolar disorder or depression is, by far, the biggest predictor of suicide, Dr. Patorno and her colleagues factored the patient's diagnosis (and a range of other health variables) into their analysis. Patorno says. The results "argue that the risk was derived from the specific drug that the patient was taking and not their underlying conditions," Dr.
Patorno and her colleagues analyzed the risk of suicidal behavior associated with specific drugs. They compared the drugs to one in the class -- topiramate (Topamax) -- because it is widely used and prescribed for a range of conditions. Unlike the FDA report, which looked at the class of drugs as a whole, Dr.
It's still not clear whether these risks are related to the drugs themselves or to underlying mood problems.
Suicidal thinking and acts are "very, very rare," says Carl Bazil, MD, a professor of clinical neurology and the director of the Columbia Comprehensive Epilepsy Center, in New York City.
Experts caution that patients should not stop taking the drugs -- gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), tiagabine (Gabitril), and valproate (Depakote) -- without their doctor's permission.
Therefore, the comparison group may have already been at lower risk of suicidal thoughts or attempts, he says.
If she were taking one of the riskier medications herself, Dr. Patorno adds, she "would probably re-evaluate the therapy" in consultation with her physician.
In the new study, a team of researchers led by Elisabetta Patorno, MD, a research fellow at Brigham and Women's Hospital, in Boston, looked at prescription data for 13 different anticonvulsants from health plans across the country and compared them to federal death records and data on emergency room visits and hospitalizations.
"These drugs definiy are being used more and more by psychiatrists to treat patients with a variety of psychiatric disorders, but primarily mood and anxiety disorders," says Dr. Kanner.
Although they are often considered as a class, anticonvulsants in fact have varied mechanisms and effects, says Andres M. Valproate and lamotrigine tend to stabilize mood, for instance, while pregabalin (Lyrica) -- which was not found to increase suicide risk in the study -- has antianxiety effects, he says. Kanner, MD, a professor of neurological sciences and psychiatry at Rush Medical College, in Chicago.
(The agency stopped short of requiring a so-called black box warning similar to those found on the labels of other antidepressant drugs, however.). As a result, the FDA required that the label of all anticonvulsants carry a warning about this increased risk.
Food and Drug Administration (FDA) that found that taking anticonvulsants (as this class of drugs is known) roughly doubled the risk of suicidal thoughts and suicide attempts, although the absolute risk remained small -- less than half of 1 percent. The study, published this week in the Journal of the American Medical Association, echoes a 2008 review by the U.S.
The study was funded by the Harvard School of Public Health and HealthCore, a research subsidiary of WellPoint, a health benefits company that serves the Blue Cross Blue Shield network.
These codes can be imprecise, Dr. Bazil says, and doctors who suspect that a patient has (or is at risk for) depression may decide to prescribe one anticonvulsant versus another for that reason, without necessarily listing the billing code for depression in the patient's file.
Patorno and her team used standardized insurance-billing codes to determine a patient's diagnosis. According to Dr. Bazil, another limitation of the study is that Dr.