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.