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Anti-epileptic drugs and suicide

Anti-epileptic drugs and suicide

5th February, 2008

Recently the Food and Drug Administration (FDA) in the United States released a statement advising doctors that there appears to be an increased risk of suicide in patients with epilepsy. They came to this conclusion after reviewing the results of 199 drug studies. Over 43 000 patients participated in these studies. Many of the patients studied had epilepsy, though some had other conditions. Patients were randomly assigned to receive either an anti-epileptic drug or a placebo. (A placebo is an inert substance that has no effect at all.) The FDA have brought attention to the fact that the patients who received an anti-epileptic drug had approximately twice the risk of committing suicide, or thinking of committing suicide, when compared with patients who received a placebo.

This is an important finding, although it needs to be stressed that the absolute risk of suicide is actually very low. Only 4 of the 27 000 patients who received an anti-epileptic drug actually committed suicide. The FDA concluded that 4 people per thousand who receive an anti epileptic drug will either commit suicide or think of it compared with 2 people per thousand who receive a placebo.

Doctors have known for many years that some patients with epilepsy become depressed. There are many reasons for this, including the loss of a drivers licence, and sometimes the loss of employment. We have also recognised that some patients have an adverse reaction to drugs, and that an occasional patient becomes depressed when they start an antiepileptic drug. This notification from the FDA allows us to quantify this risk more precisely. The FDA also points out that the risk seems to apply to antiepileptic drugs as a class, and the problem is not confined to one or two particular drugs.

As with any condition, it is important to weigh up the risks of treatment against the risks of the underlying condition. We believe that for most people with epilepsy, the risk of a complication of a major seizure greatly outweighs the risk of the treatment. However, it is important for patients, families and doctors to all recognise that antiepileptic drugs can occasionally cause a person to become depressed, though as stated above, the actual risk of suicide is quite small.

Most patients currently taking an antiepileptic drug will not need to change anything. If a patient taking an antiepileptic drug does feel suicidal or depressed, then they should speak with their doctor. We need to stress that patients should not stop their antiepileptic drugs of their own accord, since there is a risk that a person will develop a series of seizures in rapid succession if they do so (status epilepticus), and this can sometimes result in serious injury or even death.

Peter Bergin
Neurologist Auckland,
President of the New Zealand League Against Epilepsy


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