Suicide attempts in patients with bipolar disorder tend to precede, not follow, initiation of antiepileptic drugs.

To the Editor: In 2008, the US Food and Drug Administration (FDA) issued an alert stating that antiepileptic drugs (AEDs) can increase suicidal thoughts and behaviors.1 However, subsequent studies found conflicting evidence regarding the relationship between antiepileptic drugs and suicidal behavior.2–4 Furthermore, the American Epilepsy Society and others have cautioned against the unintended consequences of putting warnings on safe drugs.2,3,5 We examined the timing of suicide attempts in relation to initiation of antiepileptic drugs among patients with bipolar disorder.