Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans

Mary Jo V Pugh, Laurel A. Copeland, John E. Zeber, Chen-pin Wang, Megan E. Amuan, Eric M. Mortensen, Jeffrey V. Tabares, Anne C. Van Cott, Toby L. Cooper, Joyce A. Cramer

Research output: Contribution to journalArticle

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Abstract

Objectives To examine the association between antiepileptic drug (AED) receipt and suicide-related behavior (SRB) in older veterans. Design Retrospective database analysis. Setting Veterans Health Administration (VHA) inpatient and outpatient care. Participants Veterans aged 65 and older in 2004 to 2006. Measurements SRB was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes, and new AED monotherapy was identified using the VHA product variable in pharmacy data. Comorbid conditions and medications were also identified as potential confounders using previously validated algorithms. Cox proportional hazards models controlling for the propensity to receive AEDs examined the association between any AED exposure, specific AEDs, and time to SRB. Results Within the eligible sample of 2.15 million individuals, 332 cases of SRB were found. Overall, 98% of participants were male, and 67% were non-Hispanic white. Affective disorders and severe psychiatric conditions were strongly associated with SRB and were included in the propensity score. AED exposure displayed a significant association with SRB (odds ratio = 4.10, 95% confidence interval (CI) = 3.85-6.63) after adjusting for propensity to receive AEDs. Stratified analyses found similar results for those with (hazard ratio (HR) = 4.00, 95% CI = 2.9-5.5) and without (HR = 4.57, 95% CI = 1.15-18.20) mental health comorbidities. Gabapentin, phenytoin, lamotrigine, levetiracetam, topiramate, and valproate were significantly associated with SRB. Conclusion Exposure to five common AEDs was associated with SRB in older VHA beneficiaries. Given the strong associations between psychiatric comorbidity and SRB, clinicians treating elderly adults should weigh this potential adverse effect into their consideration for treatment of those receiving AEDs. Particular attention should be given to depression and suicidality screening in people prescribed AEDs.

Original languageEnglish (US)
Pages (from-to)2042-2047
Number of pages6
JournalJournal of the American Geriatrics Society
Volume60
Issue number11
DOIs
StatePublished - Nov 2012

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Veterans
Anticonvulsants
Suicide
Veterans Health
United States Department of Veterans Affairs
etiracetam
Confidence Intervals
Psychiatry
Comorbidity
Propensity Score
Valproic Acid
Phenytoin
International Classification of Diseases
Ambulatory Care
Mood Disorders
Proportional Hazards Models
Inpatients
Mental Health
Odds Ratio
Databases

Keywords

  • antiepileptic drugs
  • epidemiology
  • geriatrics
  • psychiatric disorders
  • suicide

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Pugh, M. J. V., Copeland, L. A., Zeber, J. E., Wang, C., Amuan, M. E., Mortensen, E. M., ... Cramer, J. A. (2012). Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans. Journal of the American Geriatrics Society, 60(11), 2042-2047. https://doi.org/10.1111/j.1532-5415.2012.04207.x

Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans. / Pugh, Mary Jo V; Copeland, Laurel A.; Zeber, John E.; Wang, Chen-pin; Amuan, Megan E.; Mortensen, Eric M.; Tabares, Jeffrey V.; Van Cott, Anne C.; Cooper, Toby L.; Cramer, Joyce A.

In: Journal of the American Geriatrics Society, Vol. 60, No. 11, 11.2012, p. 2042-2047.

Research output: Contribution to journalArticle

Pugh, MJV, Copeland, LA, Zeber, JE, Wang, C, Amuan, ME, Mortensen, EM, Tabares, JV, Van Cott, AC, Cooper, TL & Cramer, JA 2012, 'Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans', Journal of the American Geriatrics Society, vol. 60, no. 11, pp. 2042-2047. https://doi.org/10.1111/j.1532-5415.2012.04207.x
Pugh, Mary Jo V ; Copeland, Laurel A. ; Zeber, John E. ; Wang, Chen-pin ; Amuan, Megan E. ; Mortensen, Eric M. ; Tabares, Jeffrey V. ; Van Cott, Anne C. ; Cooper, Toby L. ; Cramer, Joyce A. / Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans. In: Journal of the American Geriatrics Society. 2012 ; Vol. 60, No. 11. pp. 2042-2047.
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abstract = "Objectives To examine the association between antiepileptic drug (AED) receipt and suicide-related behavior (SRB) in older veterans. Design Retrospective database analysis. Setting Veterans Health Administration (VHA) inpatient and outpatient care. Participants Veterans aged 65 and older in 2004 to 2006. Measurements SRB was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes, and new AED monotherapy was identified using the VHA product variable in pharmacy data. Comorbid conditions and medications were also identified as potential confounders using previously validated algorithms. Cox proportional hazards models controlling for the propensity to receive AEDs examined the association between any AED exposure, specific AEDs, and time to SRB. Results Within the eligible sample of 2.15 million individuals, 332 cases of SRB were found. Overall, 98{\%} of participants were male, and 67{\%} were non-Hispanic white. Affective disorders and severe psychiatric conditions were strongly associated with SRB and were included in the propensity score. AED exposure displayed a significant association with SRB (odds ratio = 4.10, 95{\%} confidence interval (CI) = 3.85-6.63) after adjusting for propensity to receive AEDs. Stratified analyses found similar results for those with (hazard ratio (HR) = 4.00, 95{\%} CI = 2.9-5.5) and without (HR = 4.57, 95{\%} CI = 1.15-18.20) mental health comorbidities. Gabapentin, phenytoin, lamotrigine, levetiracetam, topiramate, and valproate were significantly associated with SRB. Conclusion Exposure to five common AEDs was associated with SRB in older VHA beneficiaries. Given the strong associations between psychiatric comorbidity and SRB, clinicians treating elderly adults should weigh this potential adverse effect into their consideration for treatment of those receiving AEDs. Particular attention should be given to depression and suicidality screening in people prescribed AEDs.",
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AU - Mortensen, Eric M.

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N2 - Objectives To examine the association between antiepileptic drug (AED) receipt and suicide-related behavior (SRB) in older veterans. Design Retrospective database analysis. Setting Veterans Health Administration (VHA) inpatient and outpatient care. Participants Veterans aged 65 and older in 2004 to 2006. Measurements SRB was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes, and new AED monotherapy was identified using the VHA product variable in pharmacy data. Comorbid conditions and medications were also identified as potential confounders using previously validated algorithms. Cox proportional hazards models controlling for the propensity to receive AEDs examined the association between any AED exposure, specific AEDs, and time to SRB. Results Within the eligible sample of 2.15 million individuals, 332 cases of SRB were found. Overall, 98% of participants were male, and 67% were non-Hispanic white. Affective disorders and severe psychiatric conditions were strongly associated with SRB and were included in the propensity score. AED exposure displayed a significant association with SRB (odds ratio = 4.10, 95% confidence interval (CI) = 3.85-6.63) after adjusting for propensity to receive AEDs. Stratified analyses found similar results for those with (hazard ratio (HR) = 4.00, 95% CI = 2.9-5.5) and without (HR = 4.57, 95% CI = 1.15-18.20) mental health comorbidities. Gabapentin, phenytoin, lamotrigine, levetiracetam, topiramate, and valproate were significantly associated with SRB. Conclusion Exposure to five common AEDs was associated with SRB in older VHA beneficiaries. Given the strong associations between psychiatric comorbidity and SRB, clinicians treating elderly adults should weigh this potential adverse effect into their consideration for treatment of those receiving AEDs. Particular attention should be given to depression and suicidality screening in people prescribed AEDs.

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