Temporal Trends and New Exposure to Antiepilepsy Drug Monotherapy and Suicide Related Behavior

In the October 30, 2013, articles ahead of print in the journal Neurology, Dr. Pugh and colleagues representing a large consortium of investigators sought out to establish the risk of suicide related behavior in individuals who are receiving antiepilepsy drugs in the Veterans Health Administration system.

• The researchers, utilizing the Veterans Health Administration databases, identified veterans aged greater than 65 years who received a new antiepilepsy drug prescription between the years 2004 and 2006. All instances of suicidal related behavior were identified a year before and after the initiation of an antiepilepsy drug.
• The investigators calculated the risk of suicide related behavior in a group of 90,263 older veterans the month prior to antiepilepsy drug exposure and found a significantly higher risk than in other time periods even after adjusting for potential explanations.
• There were 87 suicide related behavioral events, which corresponded to 74 individuals the year before; and 106 suicide related behavioral events, which corresponded to 92 individuals after initiation.
• The researchers found 22% or 16 of those also had suicide related behaviors before the initiation of medications.
• Moreover, the rate of suicide related behavior after initiating an antiepilepsy drug gradually reduced over time.
• The authors concluded that antiepilepsy drug exposure and the suicide related behaviors will peak prior to initiation of medication.
• The gradual reduction in suicide related behavior after suggests that the actual symptoms of suicide related behaviors is what may be prompting prescription with an antiepilepsy drug, thus causing the sense of suicide related behaviors as opposed to the medications being responsible.