Suicide Attempt Following Initiation of Topiramate

To the Editor: Topiramate is approved for monotherapy in partial seizures, generalized tonic clonic seizures, and migraine prophylaxis (1) . Topiramate has been reported to increase suicidality in patients with psychiatric illness (2) . To our knowledge, there are no published reports of suicidal ideation or suicide attempts in patients without preexisting psychiatric illness. We present a case report of a patient without preexisting mental illness who ingested ethylene glycol while receiving topiramate.

The mechanism of action in topiramate remains elusive (3) ; however, it is known to diminish functioning of the frontal lobes (4) . In rats and humans, topiramate causes significant disruption in working memory, a process that relies on the frontal cortex (5 – 7) . Since the frontal cortex functions as an important inhibitor of impulsivity, one could hypothesize that our patient’s suicide attempt was a result of topiramate-induced decrease in frontal lobe activity. Further investigation is warranted on the effect of topiramate on impulsivity, since impulsive behavior is a significant risk factor for self-harm. In addition, it is imperative that clinicians continue to monitor and report adverse events to the Food and Drug Administration.