Neuronal stabilizing agents, aka anticonvulsants or antiepileptic drugs, are among the most prescribed medications for Migraine and headache prevention. They're also used to treat some mental health disorders (bipolar disorder, depression, anxiety) as well as, of course, seizure disorders such as epilepsy. Pregabalin (Lyrica) was recently approved for the treatment of fibromyalgia. The FDA has now has analyzed reports of suicidality (suicidal behavior or ideation) from 199 placebo-controlled clinical studies of 11 of these medications:
- Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
- Felbamate (Felbatol)
- Gabapentin (Neurontin)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Oxcarbazepine ( Trileptal)
- Pregabalin (Lyrica)
- Tiagabine (Gabitril)
- Topiramate (Topamax)
- Valproate (Depakote, Depakote ER, Depakene, Depacon)
- Zonisamide (Zonegran)
The studies examined the effectiveness of the drugs in epilepsy, psychiatric disorders (e.g., bipolar disorder, depression and anxiety) and other conditions (e.g., migraine and neuropathic pain syndromes). The analysis included a total of 43,892 patients ages five and older (27,863 in drug treatment groups and 16,029 in placebo groups).
There was a statistically significant increased risk of suicidal behavior and suicidal ideation in the patients randomized to receive a neuronal stabilizing agent compared to patients who received a placebo. The estimated overall risk was about twice that of the placebo group. There were an estimated 2.1 per 1000 more patients in the drug treatment groups who experienced suicidal behavior or ideation than in the placebo groups.
Four of the patients who were taking one of the antiepileptic drugs took their own lives, whereas none of the patients in the placebo group did. The increased risk of suicidal behavior and suicidal ideation was observed at one week after starting the drug and continued to at least 24 weeks. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be reliably assessed.