Some anti-seizure drugs linked to suicide risk--study

Anticonvulsant medications are used to treat patients with epilepsy and a host of other conditions like bipolar disorder, mania, neuralgia, migraine, and neuropathic pain.

According to experts, a certain class of seizure medicines like Pfizer's Neurontin (gabapentin) and Novartis' Trileptal (oxcarbazepine), can promote suicidal behavior in newly-treated patients.

Study author, Dr Elisabetta Patorno, of Brigham and Women's Hospital and Harvard Medical School stated, "Anticonvulsant medications have important therapeutic benefits, but they also have associated risks that both provider and patient need to remain aware of.

"Physicians should discuss associated risks and benefits with their patients, and together determine the best treatment course for the underlying medical condition.

"Both patients and health-care professionals should be alert to early symptoms that might potentially be associated with suicidal risk."

Data of 300000 patients analyzed
The researchers carried out a study to assess whether individual anticonvulsant medications raise the risk of attempted or completed suicide.

They analyzed data from HealthCore Integrated Research Database covering specifically 3,00,000 patients aged 15 and older in 14 states, who began the anti-seizure therapy between 2001 and 2006.

The study identified a total of 827 suicidal acts which comprised of 801 attempted suicides, 26 completed suicides, and 41 violent deaths linked with use of an anticonvulsant.

The researchers noted that risk of suicidal thoughts was higher in patients taking gabapentin, lamotrigine, oxcarbazepine, tiagabine, and valproate as opposed to those taking topiramate.

The increased risk began about 14 days after the start of treatment.

The study authors also stated, "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."

Reasons for increased risk of suicidal behavior unclear
Though certain anticonvulsants are linked to the risk of suicidal behavior, the link is unclear.

Though medicines are known to produce mood and behavior changes, the researchers are unsure whether the suicidal tendencies are promoted by the patient's mental state or the drug itself.

On the basis of a so-called meta-analysis of nearly 200 clinical trials, the U.S. Food and Drug Administration (FDA) requires all drugs classified under the anticonvulsant drug category to carry a warning that they enhance the risk of suicide thoughts.

Perhaps there is need for a stronger black box warning on the medication.

Nevertheless, since the benefits outweigh the risks involved, experts advise patients to continue with the medication and to quit treatment only after consultations with the doctor.

However, as a precautionary measure, patients need to be watched carefully for any obvious signs of suicidal tendencies.

Details of the study are published in the Journal of the American Medical Association (JAMA).