Despite all the warnings on epilepsy drugs increase the risk of suicidal behavior, it is simply impossible, because the risks associated with new drugs, a study published Monday.
In a study of patients in the United Kingdom 44 300 drug seizures in 1990-2005, the researchers found an increased risk of suicide, attempted suicide or self harm “only among users of certain new drugs previously associated with risk of depression.
Drugs, including topiramate (Topamax), vigabatrin tiagabine (Gabitril), levetiracetam (Keppra) and (Sabril).
The results published in the journal Neurology, add to the debate about the Food and Drug Administration’s decision in 2008 which requires that all drugs for epilepsy warning on the risk of suicidal behavior to contribute.
This step comes from the analysis “of 199 meta-FDA clinical trials testing 11 different drugs against seizures. Analysis, which combines results from all studies show that patients treated with higher levels of suicidal thoughts and behavior during the study period compared with placebo – .4 percent, 0.2 percent.
Analysis shows, however, can not distinguish whether the risks associated with certain drugs. And critics argue that all epilepsy drugs need warnings of suicide and widths are not all wearing the same drug.
These latest findings provide some support for this statement. But this does not mean that the drug involved in this research is to link only with the risk of suicide, according to researchers and others who reviewed the research.
First, this conclusion is based on assessments from a database of information – a plan of study can not prove causality.
In addition, suicide is only a small number of documented suicides or attempted self harm if (self-injury without a clear purpose to commit suicide), by Dr. Frank Andersohn and colleagues at the Charité-University Medical Center in Berlin.
The researchers found 453 cases in all 44 300 patients, based on a database of UK Electronic Health Record.
He then tried to reduce the risk of suicidal behavior and wound visible in accordance with various types of epilepsy drugs. Topiramate, tiagabine, levetiracetam and vigabatrin are classified as new drugs with “high risk” of depression – based on the fact that in clinical trials, more than 1 percent of patients using the drug developed depression.
Other groups include four new drug is considered as a lower risk of depression: Neurontin (gabapentin) have, lamotrigine (Lamictal), oxcarbazepine (Trileptal) and pregabalin (Lyrica). Two other groups of barbiturates and old drugs such as valproate epilepsy (Depakine, Epilim), carbamazepine (Carbatrol, Tegretol).
Overall, the researchers found a three-times larger than the behavior of suicide or self harm among user groups today, including topiramate, tiagabine, levetiracetam and vigabatrin, compared with patients with epilepsy is not used drugs during the past year.
However, the figures, again, is still low.
There are only two cases each current user topiramate, levetiracetam and vigabatrin, tiagabine, and none in between users.
The result, therefore, must “be interpreted with caution and confirmed in future studies, Andersohn and colleagues write.
This result differs from a study released in April in the Journal of JAMA. In this study, researchers found that new users gabapentin, lamotrigine, oxcarbazepine and tiagabine increases the risk of suicide than topiramate – a drug associated with increased risk in recent studies.
Editorial published with the study agree that this is an attempt to “good start” to see a complex question, but we need to work more.
Epilepsy itself is associated with higher depression than average and thoughts of suicide, said Dr. W. Josemi Sander of the University College London, UK, columnist. Does she told Reuters Health in an e-mail, it might be difficult to “decipher” effects that might arise from his own epilepsy drug.
“The fact that an investigation of this problem seems different answers, but I think the answer is not easy to be emphasized again,” said Sander.
A limitation of this study is that it does not have a detailed description of the forms of epilepsy patients and each co-existing psychiatric disorders, according to Sander.
There was “doubt”, he explained that various groups of people with epilepsy, and some patients more susceptible to increased risk of suicidal behavior in connection with drugs.
For now, Sanders said, is important for people with epilepsy have a psychiatric assessment before starting any new medicines – a step the FDA advised doctors to take.
Indeed, the key message for people with epilepsy is the most important factor in the risk of suicidal thoughts or behavior or a history or family history of depression or fear, according to Dr. Andres Kanner A professor of neuroscience at Rush Medical College in Chicago, and president of the American Epilepsy Society task on psychiatric aspects of epilepsy.
Anticonvulsants can develop some suicidal thoughts and behavior of people at risk to facilitate Kanner told Reuters Health, but the potential risks associated with the drug itself will be low.
“Make sure your doctor knows if you have a history of depression or anxiety,” Kanner’s suggestion, indicates that the personal or family history. Your doctor may consider that in the overall management of patients with epilepsy.
For the future, “said Sander remained” urgent “for clinical trials on medicinal products for people with epilepsy are different in the subgroup of patients to see a clearer picture from the risk of” any facility in the eyes of the drug. ”
This research was funded by Bayer Schering Pharma factory, and two co-authors on the road acting as a consultant for Novartis and Sanofi-Aventis – manufacturer of both drugs was not associated with suicide risk in this study.
Sander and co-author of the editorial has relationships with various manufacturers of anti-epileptic drugs – including the people and not associated with suicide risk in this study. Business UCB (Keppra maker), Pfizer (Neurontin) and GlaxoSmithKline (Lamictal).
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