Sunday, August 8, 2010

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.

1 comment:

  1. Hi, Dr. Wyler

    The treatment of epilepsy will always be a complex issue, with complex and varying results, and rate of success, which degree of success can also vary over time. Further, you know how close the connection is between brain neuronal function, mood, and behavior.

    I feel any increase in suicidal behaviors, whether attempted (as in some personality disorders) or the unfortunately successful suicide, is due to similarly complex pathology and disorder. Neuronal dysfunction leads to though or mood disorders, depression, and is further aggrevated by the social isolation, difficulty in finding employment, and lowered self-esteem many patients with epilepsy face. Medications can also complicate patients' function, especially in patients who have refractory, difficult-to- control epilepsy.

    Having known your work in the past, I am proud to have worked with you, and have seen many patients who underwent successful surgery for their epilepsy, and reported significantly improved mood and cognition in their postoperative course.

    Regardless of the degree of connection between medication and suicide, we see it is vital (in the truest sense of the word) to get patients the best control of their seizures by any means possible.