Anti-Seizure Drugs May Pose Risk of Suicidality
> 5/21/2008 2:52:00 PM


Approximately 1% of the general population (at least 3 million Americans) endure some form of the seizure disorder epilepsy, and the vast majority take daily medications to prevent the symptomatic attacks that can interfere with their well-being and, in severe cases, threaten their lives. Seizures might range from inconvenient to dangerous, but almost all patients testing positive for a seizure disorder will receive prescriptions for related drugs.

In early 2008, the Food and Drug Administration released problematic news for the makers of some of the world's most popular anti-seizure medications, as well as for thost who rely on these medications. In addition to countering the neural spasms characterizing epilepsy and related conditions, these drugs may also increase suicidal ideation among some patients. While the main drugs listed were Neurontin, Tegretol, Depakote and Topamax, the FDA also cryptically added that the warning should apply to all anti-seizure drugs. Additionally, many of these drugs have been recommended by their manufacturers as treatments for disparate conditions, so the FDA’s announcement has affected more than the 3 million Americans who have epilepsy.

The anti-seizure/suicide link is not entirely new. The FDA brought the issue to the attention of the pharmaceutical industry in 2005 and required them to formally examine possible links between some of the most popular anti-convulsant drugs and a patient propensity toward suicidal ideation. For their 2008 announcement, the FDA examined a sizable series of studies that tracked the progress of nearly 45,000 epileptic patients. Some had been medicated with anti-seizure drugs, while others had been medicated with placebo. Thankfully, very few of those involved reported suffering from thoughts of self-harm and suicide, but among those who did, the statistics tell a somewhat disturbing story. Numbers represented here are small— only .43% of the sizable (nearly 30,000) medicated population reported thoughts of suicide or related behaviors. But when compared to the same variable in the placebo group, that statistic becomes more relevant; the presence of these inclinations was twice as great among the medicated patients. Approximately 2 in 1000 placebo patients had suicidal thoughts. 4 in 1000 medicated patients did. The most tragic statistic to emerge from this study: 4 patients in the treatment group committed suicide during the study. No suicides were reported among the placebo group.

Epilepsy, with or without medication, is associated with higher rates of depression and suicidal ideation. The trauma that often envelops the severely epileptic brain can very easily be seen as a major contributor to coexisting conditions. But these medications do not always offer a solution. Many patients with lesser forms of epilepsy can live without medication, and these medications could interact with other drugs in undesirable ways. But for many more, anti-seizure medications prove essential, and the FDA’s report reinforces the importance of erring on the side of caution when administering prescriptions and carefully monitoring patients at risk for suicide.

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