For years it has been known that people taking antiepileptic drugs (AED) have a higher risk for suicide. The question has been, what is responsible for this; the disease for which a patient is being treated or the drugs used to treat it? Examples of common illnesses treated with AEDs are chronic pain, depression, and bipolar disorder.
In January 2008, the FDA issued a safety alert on the risk for suicidality in people taking AED medications. The alert stemmed from analysis of 199 placebo-controlled AED trials of 11 AEDs. It found a 2-fold increased risk for suicidal thoughts or actions among AED-treated patients compared with placebo-treated patients and suggested that the risk was increased regardless of AED type and indication for use. However, the assessment of suicidality in analysis was "subject to several limitations such as the lack of systematic or standardized language to define suicidal ideation and behavior across clinical trials." To investigate further, data from The Health Improvement Network database looked at the association between AEDs and "harder" endpoints (attempted and completed suicides) in patients with epilepsy, depression, or bipolar disorder.
A new study in the August 5 issue of The New England Journal of Medicine suggests that it might not be antiepileptic drugs (AEDs) themselves that raise the suicide risk in patients, but the underlying disease for which these drugs are prescribed. This new study analyzed more than 5 million patients, so the validity of the data is quite compelling.