Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior

Mailman School of Public Health (D.H.), Sergievsky Center, The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY
Neurology (Impact Factor: 8.29). 10/2013; 81(22). DOI: 10.1212/01.wnl.0000436614.51081.2e
Source: PubMed


Because some recent studies suggest increased risk for suicide-related behavior (SRB; ideation, attempts) among those receiving antiepileptic drugs (AEDs), we examined the temporal relationship between new AED exposure and SRB in a cohort of older veterans.
We used national Veterans Health Administration databases to identify veterans aged ≥65 years who received a new AED prescription in 2004-2006. All instances of SRB were identified using ICD-9-CM codes 1 year before and after the AED exposure (index) date. We also identified comorbid conditions and medication associated with SRB in prior research. We used generalized estimating equations with a logit link to examine the association between new AED exposure and SRB during 30-day intervals during the year before and after the index date, controlling for potential confounders.
In this cohort of 90,263 older veterans, the likelihood of SRB the month prior to AED exposure was significantly higher than in other time periods even after adjusting for potential confounders. Although there were 87 SRB events (74 individuals) the year before and 106 SRB events (92 individuals) after, approximately 22% (n = 16) of those also had SRB before the index date. Moreover, the rate of SRB after AED start was gradually reduced over time.
The temporal pattern of AED exposure and SRB suggests that, in clinical practice, the peak in SRB is prior to exposure. While speculative, the rate of gradual reduction in SRB thereafter suggests that symptoms may prompt AED prescription.

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Available from: Craig J Bryan, Dec 30, 2013
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    • "3. The data should concern induction of any kind of suicide-related issues 4. The paper should not be limited to mood disorder patients and should not concern only the comparison of antiepileptics to lithium for the reduction of suicidality in bipolar patients A MEDLINE search (updated in December 12 th 2014) with the combination of the key words antiepileptics or anticonvulsants with suicide or suicidal returned 1039 papers. After inspection of titles and abstracts, 8 (Andersohn and others 2010; Arana and others 2010; Mula and Sander 2007; Nilsson and others 2002; Patorno and others 2010; Pugh and others 2012; Pugh and others 2013; Wen and others 2011) were chosen as relevant to the current review. The FDA report (FDA 2008) is also included. "
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    ABSTRACT: Introduction: This report from the World Psychiatric Association Section on Pharmacopsychiatry examines the possible relationship of antiepileptic drugs with suicide-related clinical features and behaviors in patients with epilepsy. Materials and methods: A systematic review of the MEDLINE search returned 1039 papers, of which only 8 were considered relevant. A critical analysis of the Food and Drug Administration (FDA) report on the increase risk for patients under antiepileptics to manifest suicidality is also included in this report. Results: The analysis of these studies revealed that the data are not supportive of the presence of a "class effect" on suicide-related behavior; on the contrary, there are some data suggesting such an effect concerning treatment with topiramate, lamotrigine, and levetiracetam for which further research is needed. Discussion: For the majority of people with epilepsy, anticonvulsant treatment is necessary and its failure for any reason is expected to have deleterious consequences. Therefore, clinicians should inform patients and their families of this increased risk of suicidal ideation and behavior, but should not overemphasize the issue. Specific subgroups of patients with epilepsy might be at a higher risk, and deserve closer monitoring and follow-up. Future research with antiepileptics should specifically focus on depression and suicidal thoughts.
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