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Antiepileptic Drugs Linked to Increased Risk of Suicidal Behaviors and Thoughts

Patients taking antiepileptic drugs had nearly twice the risk of suicidal behavior or thoughts than those taking a placebo, according to FDA analysis. Epilepsy drugs are commonly prescribed for migraine or headache prevention.

FDA informed healthcare professionals that the Agency has analyzed reports of suicidality (suicidal behavior or ideation) from placebo-controlled clinical studies of eleven drugs used to treat epilepsy as well as psychiatric disorders, and other conditions. In the FDA’s analysis, patients receiving antiepileptic drugs had approximately twice the risk of suicidal behavior or ideation (0.43%) compared to patients receiving placebo (0.22%). The increased risk of suicidal behavior and suicidal ideation was observed as early as one week after starting the antiepileptic drug and continued through 24 weeks. The results were generally consistent among the eleven drugs. The relative risk for suicidality was higher in patients with epilepsy compared to patients who were given one of the drugs in the class for psychiatric or other conditions.

Healthcare professionals should closely monitor all patients currently taking or starting any antiepileptic drug for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression.

The drugs included in the analyses include (some of these drugs are also available in generic form):

  • Carbamazepine (marketed as Carbatrol, Equetro, Tegretol, Tegretol XR)
  • Felbamate (marketed as Felbatol)
  • Gabapentin (marketed as Neurontin)
  • Lamotrigine (marketed as Lamictal)
  • Levetiracetam (marketed as Keppra)
  • Oxcarbazepine (marketed as Trileptal)
  • Pregabalin (marketed as Lyrica)
  • Tiagabine (marketed as Gabitril)
  • Topiramate (marketed as Topamax)
  • Valproate (marketed as Depakote, Depakote ER, Depakene, Depacon)
  • Zonisamide (marketed as Zonegran)

Although the 11 drugs listed above were the ones included in the analysis, FDA expects that the increased risk of suicidality is shared by all antiepileptic drugs and anticipates that the class labeling changes will be applied broadly.

I don’t know anything else right now, but will update you when I learn more.

20 Responses to Antiepileptic Drugs Linked to Increased Risk of Suicidal Behaviors and Thoughts

  1. Christy says:

    I took Topamax for seven days and by the fourth day I was frighteningly depressed and having fleeting suicidal thoughts. I had never felt that way before. I would wake up crying, eat my oatmeal crying, take the dog for a walk crying. At the same time, the Topamax was making me so confused I couldn’t figure out what to do about it. On the seventh day I called the doctor and got permission to stop taking it. The next day all the bad sad feelings were gone, but the confusion lingered for a couple of weeks. Glad to see a study validated my experience. Hope doctors are paying attention.

  2. Anette of Norway :) says:

    I tried Topamax for a very short time, as my doctor thought it could help with my chronic daily headaches and migraines. I don’t remember if I was on it just a couple of days, or a week or so… But what I do remember is the feeling of confusion, awful feelings, and the difficulty of remembering words when I spoke… And my mind would race and never rest, and even if my body was exhausted I was hardly able to sleep, because of the activity in my brain. I felt like I was “floating” inches above my bed, even if I knew that wasn’t the fact.. It just literally played with my brain! And then I experienced the first suicidal thought of my whole life.. I surprised myself by thinking that “if I just take enough of these painkillers I won’t feel any pain anymore”…not caring about the fact that if I did that, I also wouldn’t live to see another day! And that woke me up!! Right after realizing what I had been thinking about, I called a friend and she stayed with me through the night. I stopped taking Topamax straight after, and the side affects stopped 🙂 Though I did, as Christy posted as well, feel the confusion linger for a while afterwards… It scared me more than anything else I have ever experienced! I feel that I’m a pretty upbeat and cheery person, and despite my chronic headache I don’t have a lot of depression, and suicide has always been the furthest from my mind. Luckily I don’t struggle with that anymore, ever since I stopped with Topamax. I’d rather live WITH headaches, than to not live at all!

    ~a~

  3. Elle says:

    Not to say the FDA shouldn’t keep monitoring this, but remember that drugs work differently on different people. I’ve been taking Topamax for migraine for about two years now, and for the first year it was amazing. Nothing else has ever been so successful at reducing the frequency of my migraines. (I’m 44, and I’ve had migraine since I was about 8 or 9, and I’ve tried many, many remedies.)

  4. Sandi says:

    Oh my goodness. I hate that ANYONE would have to experience this, but now I feel that I have some validation, also. Thank you, Christy.

    I’ve been on my 3rd try with Topamax. I cried at almost everything, got such angry feelings (at times) that I dare not step foot into a Walmart, and experienced depression like I haven’t in a very long time (I’ve been on Welbutrin for many years and have been succesful in treating my depression).

    Last night, I had HAD it. I was only taking 25 mg of Topamax (I had been titrating up EVER SO SLIGHTLY) and the side effects were just not an option any more. I didn’t take it last night (for the 1st time in a month) and my sadness, anxiety, and anger have all but disappeared. This is so strange. I sent my neuro an email to let her know I wasn’t going to be taking it anymore. So what does she suggest? She lists several other medications that (she says) shouldn’t have the same side effects, yet when I look them up, they all sound pretty much the same. Zonegran, Neurontin, Lyrica and Keppra. Why do these docs think that if one anti-seizure med messes with my head, that others won’t? I’m so unsatisfied with my treatment, but supposedly, I have one of the best neurologists around.

    I wish all of you the best, and if you find something that works… please let me know: serendipity19652003@yahoo.com

    Blessings,

    Sandi

  5. Rachel says:

    This is very, very interesting information to me. I’ve struggled with anxiety and depression (and had some fleeting suicidal ideations) but attributed it to some outside factors going on in my life over the past year. Maybe it is the Topamax. It maybe time to give the Topamax a break. Thanks, always, for posting this very helpful information.

  6. Melissa says:

    I took Topamax for about four years, I am now 43 years old. My dosage was constantly being bumped up due to seizures until I was taking 400mg a day by June ’09. I also experienced the constant foggyness, trouble forming words, & deminished vision. I have always been a very happy, upbeat, career oriented person. I was now having trouble completing tasks, getting motivated, remembering things, and just being myself. I was on several medications and never really was able to put the blame on any one drug. In Oct of ’09 I was hit with several personal blows, and for the first time in my life, I didn’t consider my options, I fell into a deep depression, not eating for a couple of weeks and then when I was alone one afternoon, I od’d. I have two children I adore, an extended family that means the world to me, but in that moment, I couldn’t see past my pain. I just want people to see that just because you have safely been on the drug for a couple of years, is not a free pass… Please be careful… I almost lost my life!

  7. Shannon says:

    I have been on Topamax for just over two years, and I have had fleeting suicidal ideations for the past year. I have also had other side effects with this drug and have wondered whether or not it was worth the benefits. I have brain fog at work, decreased sex drive, tinglinging sensation, mild weight loss, and heart palpitations/problems when exercising. But the depressive thoughts are most disturbing and have caused me to look for other migraine treatment.

  8. holly says:

    hi- i was placed on topamax for migraines in july 09, and was basically ok, until i had reached the full dose in the second week in august. i began to cry uncontrollably at everything, and i thought i was going crazy because i couldn’t figure out why on earth i was crying. i had only experienced that with postpartum. any way, i began to have suicidal thoughts-and they seemed like they were just part of my regular thinking-like there was a voice in the background of my brain, chatting away about blowing my brains out w/my husband’s gun. and i was calmly envisioning what my brains would look like on the white tile in my bathroom. i also felt so detached from my family, and that night, as i kissed my little boy good night, i felt NOTHING. so i cried more because i couldn’t understand what was happening. but i was too ?? messed up to figure it out, and too scared to tell my husband, because i was afraid he would have me put away. finally, i told him the next day, and told him i didn’t want to be left alone. he thankfully had the presence of mind to have me stop taking the topamax, since it was the only thing different that could be affecting me. i have NEVER had suicidal thoughts before this! so any way, literally 24 hours later, i was fine! absolutely fine! i so wish the neurologist who put me on this crap would have warned me. i don’t remember seeing anything about it in the package insert. for any of you out there experiencing anything like this, you are not going crazy!! it’s just not the med for you.

  9. Pam says:

    I was prescribed Topamax for lower back pain back in 2004 & within 2 days experienced extreme anxiety, paranoia, insomnia, palpatations, and suicidal thoughts. Things got very bad the first weekend when I could not reach a medical professional to make sure it was OK to discontinue the drug. Reached my doc’s nurse on Monday morning, got the OK to stop (on the 6th day). Disordered thinking persisted for 2-3 week afterwards.

    Later, I was appalled to find out that this drug is often prescribed to teenagers with anxiety disorders (?!). As an adult I had the judgment to realize it was the drug. Imagine a naive young person trying to figure this out?

  10. Jane says:

    I’ve been on Topamax for many years and had trouble getting up to the 100 mg dose because of side effects, like not being able to remember things and speak smoothly and clearly. Finally I stopped working and that didn’t seem to matter so much so I went up from 50 mg. to 100 mg. and my headaches got a lot better but slowly over the course of about 6 months I began to start thinking about suicide more and more until it began to almost control my thoughts. I’d never had these sorts of thoughts before. It was scary because it became such an all-present compelling desire. I was crying at the littlest thing but I wasn’t really “depressed”. It was the oddest sensation. When I started thinking of ways I might actually commit suicide I decided to share my thoughts with my husband. He didn’t take me seriously at first but I think it’s because I felt I needed to act all upbeat for him and downplay the seriousness of it. But, finally I made an appointment with my doctor because it was really getting so real and she had me back off the Topamax. The intense thoughts of suicide went away almost immediately. I’m now down to 50 mg again but today I woke with those thoughts again so I’m thinking I need to get off this drug entirely after reading all these posts. The thing is, I’m having migraines every single day. Generic Imitrex gets rid of the migraine, but how am I going to get enough of it insurance-wise to cover 30 days per month? Are there any drugs out there that will help me? It feels so hopeless. I agree with the other posts that we ought to be warned of this possibility of suicide ideation!! I’ve learned from migraine workshops that people with migraines tend to be much more sensitive to drugs in general and often suffer side effects from them and need smaller doses.

  11. Evelynn says:

    I am bipolar and I had a terrible problem with topamax and suidicidal thoughts. Even though I am on a low dose, I have to wean. But I have not had any problems with lamictal. We are adding Lamictal so that I can come down from Topamax without as much depression. Lamictal usually helps with depression from my experience.

  12. Becky Rynders says:

    I feel like the suicidal thoughts should warrant a black box warning on Topamax. I never even came across a mild warning regarding this side effect when the drug was Rxed for me for migraines. I didn’t just have suicidal thoughts, I OBSESSED over suicide while I was taking it. I remember being jealous when I read a story about a woman who had committed suicide and I hadn’t had my chance yet. All the while though, I had the conscious thought on top that it wasn’t really my thoughts urging me to kill myself. I also experienced parasthesias and the “word loss” so many others have reported. I was going through nursing school at the time, and while the medication prevented migraines, learning how to do IVs when you have pins and needles sensations in your fingertips and not being able to remember important medical terms for exams and papers, was unacceptable for me. I weaned myself off of it, and the suicidal thoughts disappeared. I even remember having an, “Oh S$#T!” moment where I couldn’t believe how close I had come to killing myself.

  13. Kathy owen says:

    I believe my husband killed himself and it was because of topiramate, he kept his fears from me but shared them with a close friend. He lost so much weight and couldn’t think straight, he couldn’t remember things, i guess he became convinced that there was something wring with his brain, and that he was going to wither away. This wasn’t him at all. He had so much to live for. He kept it from me because he didn’t want me to worry. Then two weeks ago he shot himself in the head.

  14. Elizabeth says:

    Kathy, I am so very sorry for your loss. I wish I could give you words of comfort, but what I can tell you is that this medicine plays with out brain in a way that we don’t even know what way we feel and what way the topomax is making us feel. I am sure your husband loved you deeply and I am happy to see that you knew he was not himself.

  15. JKB says:

    I have been on topamax for years at 150 milligrams. Last week it was increased to 300mg and i am a disaster. I don’t want to be on the planet. I can’t stop crying. I’m angry. I suffer from bipolar and this is not helping. Am dropping down to 200 because I love my family too much and I can’t function like this. I just want to take pills and be numb.

    • abby says:

      JKB, you are a strong one — I was a disaster at 25 mgs. I wish I could give you a massive trophy — you deserve it.

      I hope that you backed WAY off of it and are starting to feel a bit better, though it will likely take some time for the drugs to clear your system enough. Do you happen to be on other meds for bipolar that could also be negatively affecting you? I’m not anti-pharmaceuticals by any means, but sometimes it can take a lot of tries to find the right balance, and adjustments might need to be made at any time.

      Remember — it’s not you, these aren’t your thoughts, it’s a drug side-effect. Stay your strong self.

  16. Jkb says:

    I backed down to my original dose of 150 and things are much better! My brain is pretty much back to normal. Those few days were awful but I pulled thru and was smart enough to know it was the meds and not me. Thanks for your kind words.

  17. George says:

    I am not alone!!! I had been taking Gabapentin for a neurological ‘disease’ that gives me severe pain in my head, eyes, teeth, tongue, scalp, neck, etc.

    After a few months I couldn’t drive any longer as every telephone pole I saw along the road turned into a target of opportunity in my mind. When I turned myself into a passenger I had continual visions and thoughts of jumping out of the car door, wondering how many times I would ‘bounce’ or roll on the pavement. My wife had to engage the child locks to prevent me from jumping out.

    The last straw was when staying in a hotel on the 5th floor with a balcony. It wasn’t that I overtly thought of jumping, I had an overwhelming urge to do so. I had almost no control of my thoughts at that time and literally had to crawl off the balcony in order not to jump.

    I finally talked to my Doctor and he immediately took me off the Gabapentin. He has now prescribed Carbamazepine which I am frankly fearful of taking. What a choice! Stop taking meds and deal with daily pain levels between 5-10, or take meds that reduce my pain levels, but have the lovely side effect of suicidal tendencies,,,,.. weeeeee!!!

  18. Jkb says:

    Luckily I’ve reduced my topomax to good dose and have added 150 mg of lamictal and fiorcet for pain when needed. So far so good even thru some ridiculous awful stress of deaths these past few months. You are very lucky to have a supportive loving wife by your side. Remind yourself when these horrid thought occur of this support system and that it’s these medications causing your thoughts. This is what pulls me thru them. And this site is also an amazing place to turn. Good luck in your journey. I send you good vibes and healing thoughts.

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