Epilepsy Drugs for Bipolar Disorder: Fewer Suicides?
Last January, the FDA warned of increased suicide risk among
patients treated with epilepsy drugs. But a new study finds fewer suicide
attempts in patients with bipolar disorder.
Even though an outside panel of experts confirmed the link between
suicide and treatment of bipolar disorder with antiseizure drugs , the panel
voted against putting a strong "black box" warning on the drugs'
labels.
Now an analysis of new data by University of Chicago researcher Robert D.
Gibbons, PhD, and colleagues suggests that epilepsy drugs actually decrease the
risk of suicide in patients with bipolar disorder.
"The present analysis provides no evidence that anti-epileptic drugs
increase risk of suicide attempts in patients with bipolar disorder," they
conclude. "Most anti-epileptic drugs and lithium are associated with reduction
in suicide-attempt rates relative to pretreatment levels in patients who are
ultimately prescribed these drugs."
Eleven drugs were included in the Gibbons analysis:
- Neurontin
- Depakote
- Felbatol
- Lamictal
- Keppra
- Trileptal
- Lyrica
- Gabitril
- Topamax
- Zonegran
- Tegretol
There's no definitive proof these drugs actually help people with bipolar
disorder. But doctors who prescribe the drugs often find them very helpful for
bipolar disorder patients for whom other treatments fail.
Bipolar disorder itself greatly increases suicide risk. A 2006 study found
that every year, 40 out of every thousand bipolar patients try to kill
themselves.
Gibbons and colleagues, whose previous work has cast doubt on the link
between antidepressants and suicide, analyzed data on nearly 48,000 bipolar
patients in a large medical-claims database.
They found that patients who received the antiepileptic drugs had the same
number of suicide attempts as those who did not receive such drugs or who
received lithium, a first-line treatment for bipolar disorder.
Interestingly, patients treated with antiepileptic drugs had far more
suicide attempts before treatment than those not treated with the drugs,
suggesting that these drugs are often given to patients with more severe
bipolar disorder.
Despite a higher rate of pretreatment suicide attempts, those treated with
antiepileptic drugs had a lower rate of suicide attempts after treatment.
Gibbons reports having served or currently serving as an expert witness for
the U.S. Department of Justice, Wyeth, and Pfizer Pharmaceuticals. The Pfizer
case, Gibbons reports, involved Neurontin, one of the drugs considered in the
study.
The study appears in the December issue of Archives of General
Psychiatry.
By Daniel DeNoon
Reviewed by Louise Chang
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