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Published: 3 March 2016

Antiepileptic Medicines and Suicide

Prescriber Update 37(1): 6-7
March 2016

Antiepileptic medicines have been associated with suicide and suicidality when used to treat epilepsy and other conditions. All patients who are taking antiepileptic medicines should be closely monitored for changes in behaviour that could indicate suicidality.

Patients, their families and caregivers should seek immediate medical advice if they have any concerns about changes in mood or behaviour.

Medicines with an indication for use in the treatment of epilepsy in New Zealand include: carbamazepine, oxcarbazepine, ethosuximide, gabapentin, pregabalin, lacosamide, lamotrigine, levetiracetam, phenobarbital, primidone, phenytoin, topiramate, sodium valproate, vigabatrin, clobazam and clonazepam.

The Centre for Adverse Reactions Monitoring (CARM) has received 31 reports of suicide, suicide attempt, suicidal tendency, suicidal ideation or thoughts of self-harm in patients taking antiepileptic medicines up until 30 September 2015 (Table 1).

Table 1: Reports to CARM of suicidality associated with use of an antiepileptic medication up until 30 September 2015 (n=total number of reports received for medicine)

  Clonazepam
(n=66)
Valproate
(n=359)
Lamotrigine
(n=144)
Topiramate
(n=90)
Gabapentin
(n=182)
Pregabalin
(n=15)
Thoughts of self-harm     2 2    
Suicidal ideation       1    
Suicidal tendency 1   2 5 5  
Suicidal attempt 5 2 1   2 1
Suicide 3 1 1   1 1
Total reports of suicidality* 6 3 5 7 8 2

* Reports may contain more than one relevant reaction term

Suicidality can occur at any point during treatment. When time to onset was reported (25 of the 31 cases reported to CARM), it varied between less than 12 hours to over five years.

In 27 reports, the indication for use was provided. These medicines were used to treat epilepsy or convulsions in seven cases, pain related indications in 11 cases, mood disorders in seven cases and obesity in one case.

Please continue to report any suspected adverse reactions to CARM. Reports can be submitted on paper or electronically (https://nzphvc.otago.ac.nz/).

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