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 language | English (US) |
|---|---|
| Pages (from-to) | 1900-1906 |
| Number of pages | 7 |
| Journal | Neurology |
| Volume | 81 |
| Issue number | 22 |
| DOIs | |
| State | Published - Nov 26 2013 |
Fingerprint
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
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 journal › Article
}
TY - JOUR
T1 - Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior
AU - Pugh, Mary Jo V
AU - Hesdorffer, Dale
AU - Wang, Chen-pin
AU - Amuan, Megan E.
AU - Tabares, Jeffrey V.
AU - Finley Garcia, Erin
AU - Cramer, Joyce A.
AU - Kanner, Andres M.
AU - Bryan, Craig J.
PY - 2013/11/26
Y1 - 2013/11/26
N2 - 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.
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.
KW - 9th revision
KW - AED 5 antiepileptic drug
KW - ClinicalModification
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.
UR - http://www.scopus.com/inward/record.url?scp=84891941630&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84891941630&partnerID=8YFLogxK
U2 - 10.1212/01.wnl.0000436614.51081.2e
DO - 10.1212/01.wnl.0000436614.51081.2e
M3 - Article
VL - 81
SP - 1900
EP - 1906
JO - Neurology
JF - Neurology
SN - 0028-3878
IS - 22
ER -