In addition to their use in the management of epilepsy, anticonvulsants are indicated for management of bipolar disorder, mania, neuralgia, migraine, and neuropathic pain. Because of their widespread use in patients with and without psychiatric comorbidity, the FDA recently investigated their safety profile. In 2008, the FDA published its meta-analysis that included data from 199 placebo-controlled trials of 11 different anticonvulsants.
That meta-analysis found that patients who took anticonvulsants faced twice the risk of suicidal behavior or ideation than did patients who took placebo. Although that study prompted the FDA to mandate that a warning label be added to all anticonvulsants, the meta-analysis was not large enough to shed light on risk associated with individual agents.
In a follow-up study just published in JAMA, Patorno and colleagues1 evaluated the risk of acts of suicide or violent death associated with individual anticonvulsants. Their cohort study focused on patients over age 14 who had first taken an anticonvulsant between July 2001 and December 2006.
In what the investigators call their exploratory analysis, they found that certain anticonvulsants appear to be associated with increased risk of suicidal acts or violent deaths. Out of 297,620 new episodes of anticonvulsant therapy, 26 suicides, 801 suicide attempts, and 41 violent deaths were identified. Those anticonvulsants that were associated with increased risk of suicidal acts and also violent deaths were new users of gabapentin(Drug information on gabapentin) (Neurontin), lamotrigine(Drug information on lamotrigine) (Lamictal), oxcarbazepine(Drug information on oxcarbazepine) (Trileptal), and tiagabine(Drug information on tiagabine) (Gabitril) compared with topiramate(Drug information on topiramate) (Topamax) or carbamazepine(Drug information on carbamazepine) (Tegretol).
The authors note that their findings are compatible with those of the FDA meta-analysis and caution that their study’s small numbers made it difficult to quantify specific risks of individual agents with confidence.