Anticonvulsants and suicide risk

January 01, 0001

Anticonvulsants and suicide risk

The US Food and Drug Administration mandated warning labeling for anticonvulsant as a class of medications regarding increased risk of suicidal thoughts and behaviors. These US authors examine the risk of suicidal acts and violent death associated with individual anticonvulsants. They performed a cohort analysis in patients beginning use of anticonvulsants compared with patients initiating a reference anticonvulsant drug (topiramate) utilizing the HealthCore Integrated Research. Cox proportional hazards models and propensity score-matched analyses evaluated risks of attempted or completed suicide and combined suicidal acts or violent death. They controlled for psychiatric comorbidities and other risk factors.

The authors found: "The study identified 26 completed suicides, 801 attempted suicides, and 41 violent deaths in 297,620 new episodes of treatment with an anticonvulsant (overall median follow-up, 60 days). The incidence of the composite outcomes of completed suicides, attempted suicides, and violent deaths for anticonvulsants used in at least 100 treatment episodes ranged from 6.2 per 1000 person-years for primidone to 34.3 per 1000 person-years for oxcarbazepine. The risk of suicidal acts was increased for gabapentin (HR, 1.42), lamotrigine (HR, 1.84), oxcarbazepine (HR, 2.07), tiagabine (HR, 2.41), and valproate (HR, 1.65), compared with topiramate. The analyses including violent death produced similar results. Gabapentin users had increased risk in subgroups of younger and older patients, patients with mood disorders, and patients with epilepsy or seizure when compared with carbamazepine."

The authors concluded: "This exploratory analysis suggests that the use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine, compared with the use of topiramate, may be associated with an increased risk of suicidal acts or violent deaths."

This study expands on earlier data, elucidating the risks of suicidal acts for individual anticonvulsants.

For the full abstract, click here.

JAMA 303(14):1401-1409, 14 April 2010
© 2010 American Medical Association
Anticonvulsant Medications and the Risk of Suicide, Attempted Suicide, or Violent Death. Elisabetta Patorno, Rhonda L. Bohn, Peter M. Wahl, et al.

Category: N .Neurological, P. Psychological. Keywords: anticonvulsants, suicide, suicidal behavior, violent death, HCIR, cohort study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 14 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.