Risk of Suicidal Thoughts Linked to Anticonvulsant Medications

I was surprised when I read the findings of this study because I take anticonvulsants precisely to prevent suicidal thoughts and behaviors.  Nothing has ever controlled it as well as Lamictal.

 

Anticonvulsants are the treatment du jour for bipolar disorder.  So then I was thinking about whether this was really a significant enough increase in risk that we should start using black box warnings and switching people off their meds.  In untreated bipolar disorder, the risk of completed suicide is around 20% (thoughts and behaviors is much higher).  So when you look at this study and see only 0.43% of participants being at risk of suicidal behavior or thoughts, that looks like a significant improvement for this particular group!  You might be able to lower that risk even more with Lithium or atypical antipsychotics, but some people can't (or won't) tolerate the side effects. 

 

(Note:  I know the estimate of the study isn't totally generalizable to people with BP specifically because it also includes patients with epilepsy, migraines, and other pain disorders.)

 

To make this more relevant to migraines...A study last May linked chronic daily headache in teens with higher suicide risk.  20% of the teens in the study were at 'high risk' for suicide.  Another study of young adults found that those with migraine were 3 times more likely to have attempted suicide than those without migraine, even when adjusting for depression, substance abuse, and other psychiatric disorders.  So, while taking an anticonvulsant might increase our risk of suicidal behaviors and thoughts over placebo, I wonder if it still lowers our risk when we look at the big picture of treating vs. not-treating. 

 

(I bet it's impossible to tell from these studies, though, because they must have screened out anyone who was having active suicidal behaviors or thoughts at the initial interview for most of these studies.  I bet they might have gotten different results if they hadn't...)

 

Hopefully that made sense.  I'm desperately lacking on sleep this week. 

This was a interesting artical. I have ben takeing a anticonvulsant for 2 years. I have noticed a change in the way I feel about myself. I am not suisidal, but your artical made me realize how indifferent I have become about life. The last few months have been worse and I notice Ihardley show any emotions witch worries me. I don't even want to do things I used to have fun doing any more. The drug has been help full with my migranes so I don't want to stop takeing it.

I had been taking Depakote for migraine prevention for a little over 2 1/2 years.  I stopped taking Depakote in mid January this year, after tapering off with my doctor's assistance.  I was so sick of not being able to remember anything - my brain felt so fried.  I couldn't remember regular words in everyday conversations and it was so embarassing.  The most scary thing was after showering one morning and washing my hair I just stood there several minutes because I couldn't remember what I was supposed to do next (apply the cream rinse of course).  It took several more months and finally I had had it!!   Right before I stopped though, I had some suicidal thoughts. I shook them off because I already knew I had become somewhat depressed and simply attributed the thoughts to the depression, not necessarily the medication.  Several weeks after I finished Depakote I realized that my mood for so long was what I call "flat".  It was not something that I had recognized had happened to me until I stopped taking it.  I do attribute the thoughts that I was having to Depakote because otherwise I would never toy with the idea of suicide.  My husband committed suicide many, many years ago and after going through that ordeal and seeing how many others were affected by it, especially my children, I would never do that to anyone.  I do feel I have more positive emotions now, I have more energy and motivation.  My appetite is returning (not necessarily a good thing)  and I feel better over all.  My memory has not miraculously returned, but I am hoping that it will at least get better.  I am keeping my migraine log and so far I'm not having any more migraines than I did on the Depakote.  I'm keeping my fingers crossed till I see my new doctor in April - ughh - such a long wait - but hopefully worth it.  Time will tell regarding preventative meds for me.  I am so hoping I don't need to be on anything any more. 

I was on depakote for a while a few years back in conjunction with Lexapro. I never had a problem with it, and the psychiatrist who prescribed gave me the depakote to increase the efficacy of the lexapro. However, when I was put on topamax, it made me so depressed. I only made it 12 days on that medication because 8 days into it I found myself thinking things that normally wouldn't cross my mind (ie. I want to take a handful of percoset and sleep for a week). I think, like all psych meds, it just depends on how the individual person reacts.

Its strange that this article appeared a month after me tapering down on zonegran I had been on this drug at only 100mg for 3 months my Dr increased my dose to 125 after about 2 weeks just a guess I started being very down it was around xmas so I thought it was related to holiday stress at first but then I had this wild thought one night I sliting my throat and continued to have such suicidal thoughts off and on almost daily I am 45 and have lost a son  but even then never thought of suicide and so I started to wonder if it could be my meds. I looked online at zonegran but it really did not refer to this but my thoughts went hand in hand with the increase well here I am about 8 weeks later on 75 mg and its amazing the difference for me. I will never go any higher.

Lisa