Docs call for deeper look at epilepsy drugs, suicide tie
BY DELTHIA RICKS
Doctors yesterday called for further analysis of newly released data suggesting patients on anticonvulsants are likely to commit suicide, attempt it, or die violently and urged physicians who’ve prescribed the drugs to talk to their patients.
Reporting in Wednesday’s Journal of the American Medical Association, researchers at Brigham and Women’s Hospital in Boston concluded five widely prescribed medications for epilepsy and other conditions are linked to potentially deadly side effects.
The medications are identified as gabapentin (sold as Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal) and tiagabine (Gabitril). Patients taking a fifth drug, topiramate (Topamax,) were somewhat less likely to harm themselves, the study found.
In addition to epilepsy, the drugs are prescribed in what the U.S. Food and Drug Administration calls “off-label” usage for bipolar disorder, mania, migraine, neuralgia and other pain syndromes. Off-label use refers to medications prescribed beyond their federal license when doctors deem the drug in a patient’s best interest.
Dr. Alan Ettinger, an epilepsy specialist at Neurological Surgery P.C. in Rockville Centre, said the study was poorly conducted and failed to analyze patients’ underlying psychiatric issues.
“There are so many different types of anticonvulsant drugs now,” said Ettinger, co-author of the textbook “Psychiatric Issues in Epilepsy.” “They all have different chemical formulas and different mechanisms of action. So it’s difficult to comprehend how an entire class of drugs with different mechanisms of action can all cause suicidal behaviors.”
He said it’s important patients not abandon medications out of fear they seed suicidal behavior. Larger, more comprehensive studies, he said, have shown a strong risk of death among epileptics who fail to take their anticonvulsants.
Led by Dr. Elisabetta Paterno, the study of 297,620 cases found 827 suicidal acts — 26 suicides and 801 attempts. The study also pinpointed 41 violent deaths while patients were on the medications. Researchers did not establish how the drugs caused self-injurious behavior. “The study was exploratory,” said Dr. Sean Hwang, interim director of the Comprehensive Epilepsy Center at Long Island Jewish Medical Center. “So the nature of the research was not to delineate the underlying cause of suicidality.”
He said depression is common among people with epilepsy and severe pain syndromes, therefore “it’s important for patients and physicians to talk about depression and anxiety.”