Contrary to US Food and Drug Administration (FDA) reports, anti-epileptic drugs (AEDs) do not increase suicide risk among bipolar disorder patients and may even be protective against suicide, say US researchers.

Although an FDA advisory committee stated in 2008 that AEDs, which are used widely in mood disorder patients, are associated with an increased risk for suicidality , the committee did not vote to place a black box warning on AEDs for this risk.

To investigate the purported association further, Robert Gibbons, from the University of Illinois at Chicago, and colleagues studied data from a medical claims database on 47,918 bipolar disorder patients with a minimum 1-year of follow-up both before and after the index date of their illness.

In all, 13,385 patients received one of the 11 AEDs included in the analysis, while 25,432 did not receive any of the 11 AEDs or lithium, the team reports in the Archives of General Psychiatry.

There was no significant difference in suicide attempts following treatment between patients given an AED and those not treated with an AED or lithium, at 13 per 1000 person-years in both groups.

Interestingly, the rate of suicide attempts was significantly greater before any AED treatment than after, at 72 per 1000 person-years and 13 per 1000 person-years, respectively.

Suicide rates among patients treated with an AED only were also significantly lower than those seen among patients not treated with a central nervous system drug, at 3 per 1000 person-years versus 15 per 1000 person-years, respectively, despite having an almost three-fold increased risk prior to treatment.

The team concludes: “The present analysis provides no evidence that AEDs increase risk for suicide attempts in patients with bipolar disorder.

“Most AEDs and lithium are associated with reduction in suicide attempt rates relative to pretreatment levels in patients who are ultimately prescribed these drugs.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009

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