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.
The Food and Drug Administration, unfortunately, has bad news for the makers of some of the world's most popular anti-seizure meds: in addition to countering the neural spasms characterizing epilepsy and related conditions, they may also increase suicidal ideation and intensify related urges among some patients. The main drugs listed are Neurontin, Tegretol, Depakote and Topamax; but the FDA cryptically adds that the warning should apply to all anti-seizure drugs. Also worth noting: many of these drugs, as is the trend, have been recommended by their manufacturers as treatment for disparate conditions (particularly as anti-depressants and pain relievers), so the announcement may well apply to more than the 3 million epileptic Americans. More than 10 million people have taken Neurontin alone.
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 current press release, the FDA examined a sizable series of studies that tracked the progress of nearly 45,000 epileptic patients - some medicated with anti-seizure drugs, some 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. Again, 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, has been linked to higher rates of depression and suicidal ideation in the past. The trauma which often envelops the severely epileptic brain can very easily be seen as a major contributor to comorbid conditions. But these medications do not always offer a solution. Many patients with lesser forms of epilepsy (particularly that of the partial or petit mal variety) can live without medication, and many of these meds also interact with other drugs in undesirable ways. Doctors should consider the risks and potential benefits of these drugs in each individual case - patients who suffer from both epilepsy and bipolar or depressive disorders should be carefully monitored for suicidal thoughts and symptoms of more profound disturbances in mood. But for many more, the medications prove essential, and the FDA's report should only serve to reinforce the importance of erring on the side of caution when administering prescriptions.
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