@article{e092d813ee0646989789b1a510c2340c,
title = "Suicide-related behaviors in older patients with new anti-epileptic drug use: Data from the VA hospital system",
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.",
author = "VanCott, {Anne C.} and Cramer, {Joyce A.} and Copeland, {Laurel A.} and Zeber, {John E.} and Steinman, {Michael A.} and Dersh, {Jeffrey J.} and Glickman, {Mark E.} and Mortensen, {Eric M.} and Amuan, {Megan E.} and Pugh, {Mary J.}",
note = "Funding Information: Anne C. Van Cott has research funding from GlaxoSmithKline. Joyce Cramer has been a consultant to Johnson and Johnson, Pfizer, Sepracor and UCB Pharma. Dr. Steinman is supported by a VA Career Development Transition Award (01-013) and a National Institute on Aging Paul Beeson Career Develop- ment Award (1K23AG030999). Dr. Steinman served as an unpaid expert witness for the plaintiff in United States ex. rel. Franklin vs. Pfizer, Inc, which alleged that Neurontin (gabapentin) was promoted for uses not approved by the FDA. Dr. Steinman also serves as co-investigator on an Attorneys General special grant funded with settlement monies from this litigation, and is a founding member of the Drug Industry Document Archive, seed money for which was provided by the plaintiff's lead lawyer in the aforementioned litigation. The other authors report no conflicts of interest. Funding Information: This study was funded by the Department of Veterans Affairs, Health Services Research and Development Service (IIR-02-274). Dr. Copeland received funding from VA Health Services Research and Development Service Merit Review Entry Program Award (MRP-05-145). The authors acknowledge and appreciate support from the South Texas Veterans Healthcare System/Audie L. Murphy Division and the VERDICT research program. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. We thank Alan Ettinger, MD for reviewing and providing comments regarding this manuscript. We also acknowledge contributions of other members of the TIGER research team: Dan R. Berlowitz MD, MPH, Janice E. Knoefel MD, Jeffrey Tabares BA, Francesca Cunningham PharmD, Omotola Hope MD, Nancy Kressin PhD, Barbara Bokhour PhD, and Marcos Restrepo MD.",
year = "2010",
month = jan,
day = "11",
doi = "10.1186/1741-7015-8-4",
language = "English (US)",
volume = "8",
journal = "BMC medicine",
issn = "1741-7015",
publisher = "BioMed Central",
}