Can Gocovri (amantadine) cause depression and suicidal thoughts?

Gocovri (Amantadine) and Risk of Depression and Suicidal Thoughts

Yes, Gocovri (amantadine) can cause depression and suicidal thoughts as documented in its FDA drug label, which explicitly warns about suicide attempts in patients taking amantadine. 1

Risk of Depression and Suicidality with Gocovri

FDA Warning Information

• The FDA drug label for amantadine specifically mentions that "suicide attempts, some of which have been fatal, have been reported in patients treated with amantadine hydrochloride" 1
• The label notes that suicidal ideation and attempts have been reported in patients both with and without prior psychiatric history 1
• Patients who attempt suicide while on amantadine may exhibit abnormal mental states including disorientation, confusion, depression, personality changes, agitation, aggressive behavior, hallucinations, and paranoia 1

Clinical Presentation of Psychiatric Effects

• Depression may occur as part of a constellation of neuropsychiatric symptoms in patients taking Gocovri 1
• Abrupt discontinuation of amantadine may precipitate depression, anxiety, and other psychiatric symptoms 1
• In clinical trials of Gocovri for Parkinson's disease, hallucinations were among the most commonly reported adverse events (21% of patients) 2

Mechanism and Risk Factors

• Amantadine can exacerbate mental problems in patients with a history of psychiatric disorders or substance abuse 1
• The pathophysiologic mechanism for suicide attempts with amantadine is not fully understood 1
• Caution should be observed when prescribing amantadine to patients being treated with other drugs having CNS effects 1

Clinical Considerations and Monitoring

Patient Selection

• Carefully assess risk-benefit ratio in patients with:
  • History of psychiatric disorders 1
  • Substance abuse history 1
  • Concurrent medications with CNS effects 1

Monitoring

• Patients taking Gocovri should be monitored for:
  • Emergence of depression 1
  • Suicidal ideation or behavior 1
  • Other psychiatric symptoms including hallucinations, which occurred in 21% of patients in clinical trials 2

Potential Benefits vs. Risks

• While Gocovri may improve some non-motor symptoms in Parkinson's disease patients, such as daytime sleepiness, it may worsen others, including cognitive impairment and hallucinations 2
• In clinical trials, Gocovri showed treatment differences favoring the medication for daytime sleepiness (p=0.006) and depression (p=0.049), but favoring placebo for cognitive impairment (p=0.038) and hallucinations/psychosis (p<0.001) 2

Comparison with Other Medications

• Unlike some antidepressants that carry black box warnings for suicidality, the mechanism of amantadine-induced suicidality appears different 3
• Medications like naltrexone/bupropion (used for weight management) also carry black box warnings for suicidal behavior/ideation in people younger than 24 years with depression 3
• Some antidepressants have been associated with increased risk for nonfatal suicide attempts, particularly in the initial treatment period 3

Clinical Recommendations

• Consider alternative treatments if a patient has a history of depression or suicidal ideation 1
• Do not discontinue Gocovri abruptly as this may precipitate delirium, agitation, anxiety, depression and other psychiatric symptoms 1
• Monitor all patients on Gocovri for changes in mood, behavior, and cognition, particularly when initiating therapy or changing doses 1
• Educate patients and caregivers about the potential risk and instruct them to report any concerning changes in mood or behavior immediately 1

Remember that while Gocovri can be effective for managing dyskinesia in Parkinson's disease, the risk of psychiatric adverse effects including depression and suicidal thoughts requires careful consideration and monitoring throughout treatment.