Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system

Anne C Vancott,Joyce A Cramer,Eric M Mortensen,Mark E Glickman,Laurel A Copeland,Michael A Steinman,John E Zeber,Jeffrey J Dersh,Megan E Amuan,Mary Jo Pugh

doi:10.1186/1741-7015-8-4

Abstract

BackgroundThe U.S. Food and Drug Administration (FDA) recently linked antiepileptic drug (AED) exposure to suicide-related behaviors based on meta-analysis of randomized clinical trials. We examined the relationship between suicide-related behaviors and different AEDs in older veterans receiving new AED monotherapy from the Veterans Health Administration (VA), controlling for potential confounders.MethodsVA and Medicare databases were used to identify veterans 66 years and older, who received a) care from the VA between 1999 and 2004, and b) an incident AED (monotherapy) prescription. Previously validated ICD-9-CM codes were used to identify suicidal ideation or behavior (suicide-related behaviors cases), epilepsy, and other conditions previously associated with suicide-related behaviors. Each case was matched to controls based on prior history of suicide-related behaviors, year of AED prescription, and epilepsy status.ResultsThe strongest predictor of suicide-related behaviors (N = 64; Controls N = 768) based on conditional logistic regression analysis was affective disorder (depression, anxiety, or post-traumatic stress disorder (PTSD); Odds Ratio 4.42, 95% CI 2.30 to 8.49) diagnosed before AED treatment. Increased suicide-related behaviors were not associated with individual AEDs, including the most commonly prescribed AED in the US - phenytoin.ConclusionOur extensive diagnostic and treatment data demonstrated that the strongest predictor of suicide-related behaviors for older patients newly treated with AED monotherapy was a previous diagnosis of affective disorder. Additional, research using a larger sample is needed to clearly determine the risk of suicide-related behaviors among less commonly used AEDs.

Highlights

The U.S Food and Drug Administration (FDA) recently linked antiepileptic drug (AED) exposure to suicide-related behaviors based on meta-analysis of randomized clinical trials
From the cohort of older Veterans Health Administration (VA) patients who received a new AED monotherapy during the study period, we identified individuals with a diagnosis of suicidal behavior or ideation using ICD-9-CM codes (V62.84 Suicidal ideation, 300.9 suicidal tendencies, E9499, E950-E958, E962.0, E980-E989) for individuals who remained on AEDs through the time of suicide attempt or ideation
After matching 12 controls to each case based on prior history of suiciderelated behaviors, epilepsy diagnosis and year of AED prescription, the case-control sample consisted of 832 individuals

Summary

Introduction

The U.S Food and Drug Administration (FDA) recently linked antiepileptic drug (AED) exposure to suicide-related behaviors based on meta-analysis of randomized clinical trials. At the end of January 2008, the FDA issued an alert indicating that antiepileptic drug (AED) treatment is associated with increased risk for suicidal ideation, attempt and completion. This decision was based on a meta-analysis of suicidal ideation and behavior in placebo-controlled clinical studies of 11 antiepileptic drugs used in the treatment of epilepsy, psychiatric disorders and other conditions (including migraine and neuropathic pain) [1]. Healthcare providers were instructed to inform patients, their families, and caregivers of the potential for an increase in the risk of suicide-related behaviors. The FDA advised providers to balance the clinical need for these medications with the elevated risk for suicide-related behaviors

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