FDA Warning

Suicide and Antiepileptic Drugs:

Is There Cause for Alarm?   Is There Potential Harm?

(Prevalence of Depression in the Epilepsy Population)

MINNEAPOLIS, February 4, 2008 - The Federal Drug Administration (FDA) just released an alert, reporting increased suicidal behavior or thinking among patients treated with antiepileptic drugs (AEDs). Patients taking AEDs should not be alarmed.   Patients should not risk seizures by ceasing to take medication.   If patients have any concerns, they should visit a physician knowledgeable about the use of antiepileptic medicine. Patients with a general diagnosis of epilepsy should have as precise a diagnosis as possible so use of medication is as appropriate as possible.

Time will tell whether the concerns raised by the FDA alert are real or not. In the meantime we must deploy sound clinical judgment and careful communication with our patients to counteract the half-information. We will continue to address the data as it becomes available. The FDA finding may be coincidental or even be a sampling problem.

The prevalence of depression is higher in people with medically refractory epilepsy than in the general population. Recent population based studies, including one performed at MINCEP Epilepsy Care, demonstrate that depression is more common in people with less severe epilepsy than in the general community.   

Recent work has demonstrated fairly conclusively that depression is a risk factor for epilepsy. In other words, according to epileptologists at MINCEP, depression is more common in people who develop epilepsy than in people who do not. Both psychiatric disorders and psychiatric reactions to medications are higher in people with brain injury, who also are at higher risk for the development of seizures.

There is a danger that the factors that increase risk for depression in epilepsy, will be ignored by patients or by physicians and that both depression and suicidal thought will be blamed on the antiepileptic drugs. Patients should not stop taking antiepileptic drugs or resist treatment when it is necessary.

MINCEP epileptologists recommend the following:  

•  Patients with new and established epilepsy should be screened for depression.

•  Clinicians need to consider avoiding medications more likely to cause depression in such patients.

•  Perhaps most importantly, patients need to learn about their own type of epilepsy and its potential acute and long-term impact.   Lack of information exacerbates the anxiety associated with the initial diagnosis and augments any underlying depressive tendencies.

•  Patients and their physicians need to discuss the possibility of a worsening depression and clarify parameters that would require further intervention.

•  Patients need to understand the dangers of sudden discontinuation of antiepileptic medication.

•  Physicians need to provide realistic information regarding prognosis, which is usually much better than most patients suspect and direct patients to appropriate resources to help ameliorate any adjustment reaction.

These suggestions are not anything new.   They are basic features of a comprehensive patient-centered approach which we have long advocated at MINCEP Epilepsy Care.

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