Only Some Epilepsy Drugs May Raise Suicide Risk

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NEW YORK (Reuters Health) - While all epilepsy drugs carry a warning about an increased risk of suicidal behavior, it may only be certain newer medications that are connected to the hazard, a study published Monday suggests.In a study of 44,300 UK patients who used epilepsy drugs between 1990 and 2005, researchers found an increased risk of suicide, attempted suicide or "self-harm" only among current users of certain newer medications that have previously been linked to a risk of depression.Those drugs include topiramate (Topamax), tiagabine (Gabitril), levetiracetam (Keppra) and vigabatrin (Sabril).The findings, published in the journal Neurology, add to a debate about the Food and Drug Administration's decision, in 2008, to require all epilepsy medications to carry a warning about the risk of suicidal behavior.The move arose from the findings of an FDA "meta-analysis" of 199 clinical trials testing 11 different epilepsy medications. That analysis, which combined the results of all the trials, found that patients receiving medication had a higher rate of suicidal thoughts and behavior during the study periods than those given a placebo -- 0.4 percent, versus 0.2 percent.The analysis was not, however, able to distinguish whether the risk was associated with any particular drugs. And critics argued that requiring all epilepsy medications to carry a suicide warning was too broad a measure, as the drugs are not all alike.These latest findings offer some support for that contention. But they do not mean that the drugs implicated in this study are the only ones connected to suicide risk, according to the researchers and others who reviewed the study.For one, the findings are based on a review of information from a database -- a study design that cannot prove cause-and-effect.Moreover, there were only a small number of documented suicides, suicide attempts or instances of self-harm (self-inflicted injuries without a clear intent of suicide), according to Dr. Frank Andersohn and his colleagues at Charite-University Medical Center in Berlin.The researchers found 453 cases among all 44,300 patients, based on a UK database of electronic medical records.They then attempted to look at the risk of suicidal behavior and self-harm according to different categories of epilepsy drug. Topiramate, tiagabine, levetiracetam and vigabatrin were grouped together as newer drugs with a "high" risk of depression -- based on the fact that in clinical trials, more than 1 percent of patients using the drugs developed depression.Another group included four newer medications considered to have a low depression risk: gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal) and pregabalin (Lyrica). The other two groups were barbiturates and older epilepsy drugs like valproate (Depakine, Epilim) and carbamazepine (Carbatrol, Tegretol).Overall, the researchers found a three-fold higher risk of suicidal behavior or self-harm among current users of the group including topiramate, tiagabine, levetiracetam and vigabatrin, as compared with patients who had not used any epilepsy medication in the past year.However, the numbers, again, were small.There were only two cases each among current users of topiramate, levetiracetam and vigabatrin, and none among tiagabine users. …