Study Suggest Certain Anticonvulsants Heighten Risk of Suicide

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The safety of anticonvulsant drugs seems to be center stage once again after a study published in the Journal of the American Medical Association found that certain types of these medications might be linked with a higher risk of suicide.

The findings indicate that certain anticonvulsants, including Pfizer's Neurontin (gabapentin) and Novartis' Trileptal (oxcarbazepine), may put newly-treated patients at a higher risk of suicidal thoughts and acts and violent deaths.

The researchers from Brigham and Women's Hospital in Boston, looked at data on patients aged 15 years and older who began taking anticonvulsant therapy between July 2001 and December 2006, in order to assess the risk associated with individual drugs.

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What the research discovered was that out of 97,620 new episodes of treatment with an anticonvulsant, 26 completed suicides, 801 attempted suicides and 41 violent deaths, and an exploratory analysis found that the risk of suicidal acts was higher in patients who took Neurontin, GlaxoSmithKline’s Lamictal (lamotrigine), Trileptal, Cephalon’s Gabitril (tiagabine) and Abbott Laboratories’ Depakote (valproate) compared to those taking Johnson & Johnson’s Topomax (topiramate).

"Anticonvulsant medications have important therapeutic benefits, but they also have associated risks that both provider and patient need to remain aware of," said study author Dr. Elisabetta Patorno. "Physicians should discuss associated risks and benefits with their patients, and together determine the best treatment course for the underlying medical condition," she said. "Both patients and health-care professionals should be alert to early symptoms that might potentially be associated with suicidal risk."

It is unclear 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.

Many have suggested that a stronger warning, such as black box warning on the medication, is warranted. Certain anticonvulsants have soared in popularity in recent years, often used off-label for psychiatric disorders such as bipolar and depression as well as various pain conditions. The drugs may be effective to treat disorders other than epilepsy, but they are not without risk.

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