%0 Journal Article
%T Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system
%A Anne C VanCott
%A Joyce A Cramer
%A Laurel A Copeland
%A John E Zeber
%A Michael A Steinman
%A Jeffrey J Dersh
%A Mark E Glickman
%A Eric M Mortensen
%A Megan E Amuan
%A Mary Pugh
%J BMC Medicine
%D 2010
%I BioMed Central
%R 10.1186/1741-7015-8-4
%X 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.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.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.At the end of January 2008, the FDA issued an alert indicating that antiepileptic drug (AED) treatment is associated with increased risk for suicidal ideation, attempt and completion. This decision was based on a meta-analysis of suicidal ideation and behavior in placebo-controlled clinical studies of 11 antiepileptic drugs used in the treatment of epilepsy, psychiatric disorders and other conditions (including migraine and neuropathic pain) [1]. A higher percentage (0.43%) of patients receiving an AED had suicidal behavior and ideation compared to patients in placebo groups (0.22%). In addition, the relative risk for suicide-related behaviors was found to be highest in patient
%U http://www.biomedcentral.com/1741-7015/8/4