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August 4, 2010

Antiepileptic Medications and the Risk of Suicide—Reply

JAMA. 2010;304(5):521-523. doi:10.1001/jama.2010.1069

In Reply: We agree with several of the points raised by Dr Neligan and colleagues. Many anticonvulsants are used for reasons other than epilepsy, especially gabapentin, whose marketing for off-label purposes resulted in widespread use without approved indication.1 We therefore used 2 different comparison groups to achieve fair comparisons for patients with and without epilepsy. We agree that the drugs' risk-benefit relationships will differ in epilepsy, in which they are a mainstay of therapy, compared with indications for which they are not effective. The short median follow-up resulted from treatment changes and short-term use, which led to censoring. However, we did account for extensive pretreatment data in our multivariate analyses.

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