In 2008, the US Food and Drug Administration issued a general warning about antiepileptic drugs (AED) increasing risk of suicide or suicidal thinking. An article in the Journal of the American Medical Association (JAMA, April 14, 2010, volume 303, page 1401) obtained additional information from large databases of health care and pharmacy organizations. The study population was 297,620 people starting on a single AED and continuing for at least 6 months. Only a minority had epilepsy, with AEDs usually being initiated for other conditions, such as pain, migraines or mood stabilization. During the study period, there were 827 suicidal acts, with 801 attempted suicides and 26 completed suicides. Attempted plus completed suicides represented 0.28% of the study population or 1 suicidal act per 360 people. Compared to topiramate (Topamax), chosen as a reference because most people using it did not have epilepsy, the risk for suicidal acts was increased by 1.42 for gabapentin (Neurontin), 1.65 for valproate (Depakote), 1.84 for lamotrigine (Lamictal), 2.07 for oxcarbazepine (Trileptal), and 2.41 for tiagabine (Gabitril). One problem with interpretation of this study, as discussed by the authors, is that the increased risk for suicide might have been from underlying conditions, rather than the AED itself. For example, people taking lamotrigine, oxcarbazepine or tiagabine had a higher baseline risk for depression, and therefore might be considered more at risk for suicide, independent of their seizure medicine. A similar argument could be made for those with severe chronic pain.

This article provides another cautionary story about AEDs and suicide. Depression and suicide are more common in people with epilepsy, and, in some cases, antiepileptic medications may add to that risk. However, the actual magnitude of the increased suicide risk is small. No one should stop or change AEDs without conferring with their physicians – doing so could entail much higher risks.