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

Mary Jo V Pugh, Dale Hesdorffer, Chen-pin Wang, Megan E. Amuan, Jeffrey V. Tabares, Erin Finley Garcia, Joyce A. Cramer, Andres M. Kanner, Craig J. Bryan

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: 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. Methods: 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. Results: 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 5 16) of those also had SRB before the index date. Moreover, the rate of SRB after AED start was gradually reduced over time. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1900-1906
Number of pages7
JournalNeurology
Volume81
Issue number22
DOIs
StatePublished - Nov 26 2013

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Anticonvulsants
Suicide
Veterans
Drug Prescriptions
Veterans Health
Drugs
United States Department of Veterans Affairs
International Classification of Diseases
Databases
Research

Keywords

  • 9th revision
  • AED 5 antiepileptic drug
  • ClinicalModification
  • FDA 5 US Food and Drug Administration
  • FY 5 fiscal year
  • GEE 5 general estimating equations
  • ICD-9-CM5 International Classification of Diseases
  • OR 5 odds ratio
  • PTSD 5 posttraumatic stress disorder
  • SRB 5 suicide-related behavior
  • VA 5 Veterans Health Administration.

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Pugh, M. J. V., Hesdorffer, D., Wang, C., Amuan, M. E., Tabares, J. V., Finley Garcia, E., ... Bryan, C. J. (2013). Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. Neurology, 81(22), 1900-1906. https://doi.org/10.1212/01.wnl.0000436614.51081.2e

Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. / Pugh, Mary Jo V; Hesdorffer, Dale; Wang, Chen-pin; Amuan, Megan E.; Tabares, Jeffrey V.; Finley Garcia, Erin; Cramer, Joyce A.; Kanner, Andres M.; Bryan, Craig J.

In: Neurology, Vol. 81, No. 22, 26.11.2013, p. 1900-1906.

Research output: Contribution to journalArticle

Pugh, MJV, Hesdorffer, D, Wang, C, Amuan, ME, Tabares, JV, Finley Garcia, E, Cramer, JA, Kanner, AM & Bryan, CJ 2013, 'Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior', Neurology, vol. 81, no. 22, pp. 1900-1906. https://doi.org/10.1212/01.wnl.0000436614.51081.2e
Pugh MJV, Hesdorffer D, Wang C, Amuan ME, Tabares JV, Finley Garcia E et al. Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. Neurology. 2013 Nov 26;81(22):1900-1906. https://doi.org/10.1212/01.wnl.0000436614.51081.2e
Pugh, Mary Jo V ; Hesdorffer, Dale ; Wang, Chen-pin ; Amuan, Megan E. ; Tabares, Jeffrey V. ; Finley Garcia, Erin ; Cramer, Joyce A. ; Kanner, Andres M. ; Bryan, Craig J. / Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. In: Neurology. 2013 ; Vol. 81, No. 22. pp. 1900-1906.
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abstract = "Objective: 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. Methods: 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. Results: 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 5 16) of those also had SRB before the index date. Moreover, the rate of SRB after AED start was gradually reduced over time. Conclusions: 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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AU - Tabares, Jeffrey V.

AU - Finley Garcia, Erin

AU - Cramer, Joyce A.

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AU - Bryan, Craig J.

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AB - Objective: 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. Methods: 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. Results: 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 5 16) of those also had SRB before the index date. Moreover, the rate of SRB after AED start was gradually reduced over time. Conclusions: 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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KW - FDA 5 US Food and Drug Administration

KW - FY 5 fiscal year

KW - GEE 5 general estimating equations

KW - ICD-9-CM5 International Classification of Diseases

KW - OR 5 odds ratio

KW - PTSD 5 posttraumatic stress disorder

KW - SRB 5 suicide-related behavior

KW - VA 5 Veterans Health Administration.

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