Study Indicates Affective Disorders Strongest Predictor of Suicidal Behavior in Elderly Veterans Receiving Anti-Epileptic Medication
In January 2008, the FDA issued an alert indicating that anti-epileptic drug (AED) treatment is associated with increased risk for suicidal ideation, attempt, and completion. However, recent concerns have been raised about the ability to make appropriate recommendations regarding AEDs in what has been termed a "data poor environment." This study sought to assess variation in suicide-related behaviors in a population not well-represented by the data used for the FDA analysis - individuals 66 years and older with new exposure to AEDs. Using VA and Medicare data, investigators analyzed suicide-related behaviors among 832 Veterans who received VA care between 1999 and 2004, and who received a new prescription for AED monotherapy without a previous AED prescription. Because certain AEDs are more likely to be prescribed for individuals with psychiatric comorbidity, investigators identified Veterans with mental health diagnoses such as affective disorders (e.g., depression, anxiety, PTSD) or serious mental illness (e.g., bipolar disorder, schizophrenia). They also identified Veterans with chronic pain, dementia, and/or profound disease burden, which can affect suicide-related behaviors.
Findings show that in older Veterans who were started on AED monotherapy, the strongest reliable predictor of suicide-related behaviors was the diagnosis of an affective disorder prior to AED treatment. Increased suicide-related behaviors were not associated with individual AEDs. However, while most Veterans in this study received AED prescriptions for gabapentin (76.8%), a trend for increased suicide-related behaviors was found among those prescribed levetiracetam or lamotrigine, but interpretation was difficult since few Veterans received either drug (0.6%). The associations between suicide-related behaviors and chronic pain or chronic disease burden were not statistically significant, but dementia was significantly associated with suicide-related behaviors (42.2% with dementia vs. 25.8% without).
Van Cott A, Cramer J, Copeland L, Zeber J, et al. Suicide-Related Behaviors in Older Patients with New Anti-Epileptic Drug Use: Data from the VA Hospital System. BMC Medicine January 11, 2010;8(1):4.
This study was funded by HSR&D. Drs. Copeland and Zeber are part of HSR&D's Veterans Evidence-Based Research, Dissemination, and Implementation Center in San Antonio, TX.