Antiepileptics May Not Elevate Suicide Risk in Patients with Bipolar Disorder

In 2008, the FDA issued a warning of elevated risk for suicidality associated with antiepileptic drugs, based on results of 199 placebo-controlled, largely short-term, clinical trials involving 11 antiepileptics in more than 43,000 patients with heterogeneous diagnoses. In the FDA's analyses, increased risk was observed as early as 1 week after starting the antiepileptic and continued through 24 weeks. Using a much more psychiatrically focused population, researchers in the current study examined rates of suicidal behaviors (suicides or attempts) during intervals when the patients were receiving or not receiving antiepileptic medications.

Participants were 199 patients with bipolar disorder seen in five centers from 1978 to 2009 and treated with valproate, carbamazepine, or lamotrigine (alone or combined). Patients receiving antidepressants or lithium were excluded, because these medications presumably increase or protect against suicidality, respectively. Analyses were adjusted for clinical propensities that might have influenced the decision to prescribe these medications. Contrary to the investigators' hypothesis, the rate of suicidal behavior was not significantly elevated with antiepileptic exposure (unexposed intervals, 6.4%; exposed intervals, 5.2%).