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© 2010 American Academy of Neurology Use of antiepileptic drugs in epilepsy and the risk of self-harm or suicidal behaviorFrom the Institute for Social Medicine, Epidemiology and Health Economics (F.A., S.N.W.), and Institute for Clinical Pharmacology and Toxicology (R.S., E.G.), Charité-University Medical Center, Berlin; and Bremen Institute for Prevention Research and Social Medicine (E.G.), University of Bremen, Germany. Address correspondence and reprint requests to Dr. Frank Andersohn, Institute for Social Medicine, Epidemiology and Health Economics, Charité-University Medical Center, 10098 Berlin, Germany frank.andersohn{at}charite.de Background: A recent meta-analysis of randomized trials revealed that antiepileptic drugs (AEDs) as a class increase the risk of suicidal thoughts and behavior. We conducted an observational study with data from the United Kingdom General Practice Research Database to investigate if an increase in risk for different groups of AEDs is also evident in clinical practice. Methods: This was a nested case-control study in a cohort of 44,300 patients with epilepsy who were treated with AEDs. Patients with self-harm or suicidal behavior were identified by predefined codes. We included 453 cases and 8,962 age-matched and sex-matched controls. AEDs were classified into 4 groups: barbiturates, conventional AEDs, and newer AEDs with low (lamotrigine, gabapentin, pregabalin, oxcarbazepine) or high (levetiracetam, tiagabine, topiramate, vigabatrin) potential of causing depression. Adjusted odds ratios (OR) were calculated using conditional logistic regression. Results: Current use of newer AEDs with a high potential of causing depression was associated with a 3-fold increased risk of self-harm/suicidal behavior (OR = 3.08; 95% [CI] 1.22–7.77) as compared with no use of AEDs during the last year. Use of barbiturates (OR = 0.66; 95% CI 0.25–1.73), conventional AEDs (OR = 0.74; 95% CI 0.53–1.03), or low-risk newer AEDs (OR = 0.87; 95% CI 0.47–1.59) was not associated with an increased risk. Conclusions: Newer AEDs with a rather high frequency of depressive symptoms in clinical trials may also increase the risk of self-harm or suicidal behavior in clinical practice. For the most commonly used other groups of AEDs, no increase in risk was observed.
Abbreviations: AED = antiepileptic drug; CI = confidence interval; FDA = Food and Drug Administration; GPRD = General Practice Research Database; OR = odds ratio.
Supplemental data at www.neurology.org Study funding: Database acquisition was funded by an unrestricted grant from Bayer Schering Pharma. The funding source had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. Disclosure: Author disclosures are provided at the end of the article. Received October 8, 2009. Accepted in final form March 19, 2010. This article has been cited by other articles:
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