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


METHODS
VA 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.


RESULTS
The 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.


CONCLUSIONS
Our 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.
VanCott
Anne C
AC
VA Pittsburgh Healthcare System, Neurology Division, Pittsburgh, PA, USA. Anne.VanCott@va.gov
Cramer
Joyce A
JA
Copeland
Laurel A
LA
Zeber
John E
JE
Steinman
Michael A
MA
Dersh
Jeffrey J
JJ
Glickman
Mark E
ME
Mortensen
Eric M
EM
Amuan
Megan E
ME
Pugh
Mary Jo
MJ
D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy*; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use; D015203:Reproducibility of Results; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States
D000927:Anticonvulsants; D010672:Phenytoin