Sunday, April 25, 2010

Research Highlights: Patients Starting Anticonvulsant Drugs Have an Increased Risk of Suicide

Patients Starting Anticonvulsant Drugs Have an Increased Risk of Suicide
By: Caroline Melhado

The Journal of the American Medical Association published an article on the increased rate of suicides among patients who are prescribed several forms of anti-convulsants. After a small meta-analysis performed by the FDA that resulted in the warning label on anti-convulsants for increased suicidal thoughts, researchers desired to perform a larger cohort study that might confirm the FDA’s findings. Researchers found that patients newly prescribed gabapentin, oxcarbazepine, lamotrigine and tiagabine compared with topiramate had a significantly increased risk of suicide.

The study cohort was composed of 297,620 individuals who had started anticonvulsant drugs at the start of the study, had not previously been on any anticonvulsant and had no history of suicide. Participants were followed for 180 days after their initial prescription fill. The study observed 827 suicidal acts and 41 violetn deaths during the study. They found that individuals on gabapentin had 5.6/1000 individuals extra cases of suicidal incidents. Patients on oxcarbazepine had a 10.0/1000 population excess, and tiagabine had a 14.1 /1000 excess compared with topiramate. These increases remained even after taking into account confounding factors such as age and patients with mood disorders.

The cause of these findings is still unknown, however anticonvulsant drugs have a plethora of psychotropic effects; that are useful in their prescription for numerous diseases. This study has a variety of limitations including residual confounding and misclassification of suicidal attempts. However, because this study is the first of its kind and size it will be instrumental to physicians looking to prescribe first line anticonvulsant to a wide range of patients.

JAMA. 2010;303(14):1401-1409.
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