Jonathan Silver, MD

Most suicidal behavior seems to be explained by behavior before treatment, but this study has limitations.

Recently, several studies have found — and the FDA has issued a warning about — a link between antiepileptic drugs (AEDs) and risk for suicide (NEJM JW Psychiatry Aug 4 2010; and Sep 3 2010). To examine the relationship of all documented suicide-related behaviors (SRBs) starting 1 year before and after AED prescription, investigators used the national Veterans Health Administration database to analyze SRBs in all 90,263 veterans age 65 or older who received a new prescription for AED monotherapy during a 4-year period (mean age, 75; 97% male).

The most common AED was gabapentin (76.2% of participants); less than 0.1% received lamotrigine. There were 84 SRB events in 74 individuals the year before AED prescription and 106 SRBs in 92 individuals afterward. However, 16 veterans with SRBs before an AED also had subsequent-year SRBs. Overall, the SRB rate declined over time. Chronic pain was common: 62% of those with no SRBs subsequent to AED, and 64% of those with subsequent SRBs. Depression was diagnosed in 66% of those with subsequent SRBs (16% of those without subsequent SRBs). Depression and bipolar disorder were significant predictors of subsequent SRBs in a multivariable model.

Citation(s):

Pugh MJV et al. Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. Neurology 2013 Oct 30; [e-pub ahead of print].