August 31, 2010
by David Gutierrez
Popular anti-seizure drugs may seriously increase a patient’s risk of suicide and violent death, according to a study conducted by researchers from Brigham and Women’s Hospital and Harvard Medical School, and published in the Journal of the American Medical Association.
The drugs, known as anticonvulsants, were initially designed for the treatment of epilepsy but are now widely prescribed “off-label” for conditions such as bipolar disorder, migraine headaches and pain.
“We all know the range of uses of these medications is very, very wide,” researcher Elisabetta Patorno said.
The researchers examined the prescription and medical records of more than 300,000 people above the age of 14 who had been prescribed an anticonvulsant for the first time between July 2001 and December 2006.
All of the drugs, they found, significantly increased a patient’s risk of attempted or successful suicide, as well as violent death by other causes. During the course of the study, there were 801 attempted suicides, 26 successful suicides and 41 violent deaths.
“We found increased risk for suicidal acts beginning within the first 14 days after treatment initiation, opening the possibility that anticonvulsant medications could induce behavioral effects prior to the achievement of their full therapeutic effectiveness,” the researchers wrote.
Based on prior studies, the FDA ruled in 2008 that all anticonvulsants must carry labels warning that they double the risk of suicidal thoughts and actions. These older studies had not been able to determine if any drugs posed higher risks than others, however.
In the current study, researchers compared the rates of suicides and violent deaths among users of topiramate (sold generically and also marketed as Topamax), gabapentin (marketed as Neurontin), lamotrigine (marketed as Lamictal), oxcarbazepine (marketed as Trileptal), tiagabine (marketed as Gabitril) and valproate (marketed as Depakine and Epilim). They found that the risk was lowest in topiramate, and roughly equal in the five other drugs.
April 14, 2010
by Lauren Cox
A class of drugs prescribed to treat conditions including migraines, chronic pain and bipolar disorder may increase suicidal tendencies, a large study has found.
Government officials raised concerns about the class of drugs called anticonvulsants in 2008 because they appeared to double the risk for suicide in studies compared with patients taking a placebo. But the Food and Drug Administration did not have studies to compare which anticonvulsant had greater suicide risks.
Now in an article in the Journal of the American Medical Association, doctors crunched statistics on the suicide risk of nearly 300,000 people who started taking one of 13 anticonvulsants between 2001 and 2006. They found that 180 days after starting medication, 26 of the 300,000 people in the study committed suicide and 801 people attempted suicide.
Doctors found the drugs gabapentin (brand name Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal) and tiagabine (Gabitril), often prescribed for pain, bipolar disorder and epilepsy, appeared to increase suicide risk significantly while topiramate (Topomax), which is commonly prescribed for migraines, increased the suicide risk but less so than the other drugs.
Researchers called the study an “exploratory analysis” but also expected the results to influence medicine.
“I would say doctors should talk with their patients about the risk of these drugs and to try to evaluate if the patient is receiving the treatment he or she needs, and balance the risk and benefits,” said Dr. Elisabetta Patorno, lead author of the study and research fellow in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital in Boston.
Patorno said clear differences appeared between the drugs — gabapentin had 40 percent higher suicide risk compared with topiramate, for example — but that the overall risk for suicide was low enough that doctors might not pick up on it in their practice.
“I would say the risk is there, it’s probably not anything to expect the practitioner on his daily basis to detect this risk, and that’s why this study is so important,” Patorno said.
Yet doctors tasked with treating epilepsy, pain and bipolar disorder say the study raises more questions to research than it provides answers.