Suicide-related Behaviors in Older Patients with New Anti-epileptic Drug Use: Data from the VA Hospital System

Overview

Journal BMC Med

Publisher Biomed Central

Specialty General Medicine

Date 2010 Jan 13

PMID 20064226

Citations 28

Authors

Anne C VanCott

Joyce A Cramer

Laurel A Copeland

John E Zeber

Michael A Steinman

Jeffrey J Dersh

Mark E Glickman

Eric M Mortensen

Megan E Amuan

Mary Jo Pugh

Affiliations

Soon will be listed here.

Abstract

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.

Conclusion: 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.

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References

Nilsson L, Ahlbom A, Farahmand B, Asberg M, Tomson T . Risk factors for suicide in epilepsy: a case control study. Epilepsia. 2002; 43(6):644-51. DOI: 10.1046/j.1528-1157.2002.40001.x. View

Pugh M, Van Cott A, Cramer J, Knoefel J, Amuan M, Tabares J . Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy: 2000-2004. Neurology. 2008; 70(22 Pt 2):2171-8. DOI: 10.1212/01.wnl.0000313157.15089.e6. View

Hesdorffer D, Kanner A . The FDA alert on suicidality and antiepileptic drugs: Fire or false alarm?. Epilepsia. 2009; 50(5):978-86. DOI: 10.1111/j.1528-1167.2009.02012.x. View

Blow F, Ullman E, Barry K, Bingham C, Copeland L, McCormick R . Effectiveness of specialized treatment programs for veterans with serious and persistent mental illness: a three-year follow-up. Am J Orthopsychiatry. 2000; 70(3):389-400. DOI: 10.1037/h0087648. View

. The management of persistent pain in older persons. J Am Geriatr Soc. 2002; 50(6 Suppl):S205-24. DOI: 10.1046/j.1532-5415.50.6s.1.x. View

Christensen J, Vestergaard M, Mortensen P, Sidenius P, Agerbo E . Epilepsy and risk of suicide: a population-based case-control study. Lancet Neurol. 2007; 6(8):693-8. DOI: 10.1016/S1474-4422(07)70175-8. View

Kikuchi N, Ohmori-Matsuda K, Shimazu T, Sone T, Kakizaki M, Nakaya N . Pain and risk of completed suicide in Japanese men: a population-based cohort study in Japan (Ohsaki Cohort Study). J Pain Symptom Manage. 2008; 37(3):316-24. DOI: 10.1016/j.jpainsymman.2008.03.012. View

Conwell Y, Brent D . Suicide and aging. I: Patterns of psychiatric diagnosis. Int Psychogeriatr. 1995; 7(2):149-64. DOI: 10.1017/s1041610295001943. View

Beautrais A . A case control study of suicide and attempted suicide in older adults. Suicide Life Threat Behav. 2002; 32(1):1-9. DOI: 10.1521/suli.32.1.1.22184. View

10.

Ettinger A, Argoff C . Use of antiepileptic drugs for nonepileptic conditions: psychiatric disorders and chronic pain. Neurotherapeutics. 2007; 4(1):75-83. PMC: 7479709. DOI: 10.1016/j.nurt.2006.10.003. View

11.

Selim A, Fincke G, Ren X, Lee A, Rogers W, Miller D . Comorbidity assessments based on patient report: results from the Veterans Health Study. J Ambul Care Manage. 2004; 27(3):281-95. DOI: 10.1097/00004479-200407000-00011. View

12.

Gilliam F . What we don't learn from clinical trials in epilepsy. Epilepsia. 2003; 44 Suppl 7:51-4. DOI: 10.1046/j.1528-1157.44.s7.2.x. View

13.

Zetin M, Hoepner C . Relevance of exclusion criteria in antidepressant clinical trials: a replication study. J Clin Psychopharmacol. 2007; 27(3):295-301. DOI: 10.1097/JCP.0b013e318058263f. View

14.

Silverman M, Berman A, Sanddal N, OCarroll P, Joiner T . Rebuilding the tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life Threat Behav. 2007; 37(3):248-63. DOI: 10.1521/suli.2007.37.3.248. View

15.

Sajatovic M, Ramsay E, Nanry K, Thompson T . Lamotrigine therapy in elderly patients with epilepsy, bipolar disorder or dementia. Int J Geriatr Psychiatry. 2007; 22(10):945-50. DOI: 10.1002/gps.1784. View

16.

Krishnan L, Petersen N, Snow A, Cully J, Schulz P, Graham D . Prevalence of dementia among Veterans Affairs medical care system users. Dement Geriatr Cogn Disord. 2005; 20(4):245-53. DOI: 10.1159/000087345. View

17.

Jones J, Hermann B, Barry J, Gilliam F, Kanner A, Meador K . Clinical assessment of Axis I psychiatric morbidity in chronic epilepsy: a multicenter investigation. J Neuropsychiatry Clin Neurosci. 2005; 17(2):172-9. DOI: 10.1176/jnp.17.2.172. View

18.

Zivin K, Kim H, McCarthy J, Austin K, Hoggatt K, Walters H . Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. Am J Public Health. 2007; 97(12):2193-8. PMC: 2089109. DOI: 10.2105/AJPH.2007.115477. View

19.

Juurlink D, Herrmann N, Szalai J, Kopp A, Redelmeier D . Medical illness and the risk of suicide in the elderly. Arch Intern Med. 2004; 164(11):1179-84. DOI: 10.1001/archinte.164.11.1179. View

20.

Shah A, Bhat R, McKenzie S, Koen C . Elderly suicide rates: cross-national comparisons and association with sex and elderly age-bands. Med Sci Law. 2007; 47(3):244-52. DOI: 10.1258/rsmmsl.47.3.244. View