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

BMC Medicine

Research Article

Megan E Amuan¹  Mark E Glickman²  Joyce A Cramer³  Michael A Steinman⁴  Anne C VanCott⁵  Jeffrey J Dersh⁶  Eric M Mortensen⁶  Mary Jo Pugh⁷  Laurel A Copeland⁸  John E Zeber⁸ 

[1] Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA, USA;Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Hospital, Bedford, MA, USA;Boston University School of Public Health, Boston, MA, USA;Department of Psychiatry, Yale University, New Haven, CT, USA;Epilepsy Therapy Project, Orange, CT, USA;San Francisco VA Medical Center, San Francisco, CA, USA;Division of Geriatrics, University of California, San Francisco, CA, USA;VA Pittsburgh Healthcare System, Neurology Division, Pittsburgh, PA, USA;Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA;Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), San Antonio, TX, USA;Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), San Antonio, TX, USA;Department of General Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA;Veterans Affairs HSR&D: South Texas Veterans Health Care System (VERDICT), San Antonio, TX, USA;Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA;

关键词: Gabapentin;    Lamotrigine;    Affective Disorder;    Levetiracetam;    Veteran Health Administration;   

DOI  :  10.1186/1741-7015-8-4

 received in 2009-09-15, accepted in 2010-01-11,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsVA 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.ResultsThe 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.ConclusionOur 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.

【 授权许可】

CC BY   
© VanCott et al; licensee BioMed Central Ltd. 2010