Antiepileptic Drugs for Bipolar Disorder and the Risk of Suicidal Behavior: A 30-Year Observational Study

Andrew C LEON; David A SOLOMON; Chunshan Li; Jess G FIEDOROWICZ; William H CORYELL; Jean ENDICOTT; Martin B KELLER

doi:10.1176/appi.ajp.2011.11060948

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Antiepileptic Drugs for Bipolar Disorder and the Risk of Suicidal Behavior: A 30-Year Observational Study

Journal article

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Antiepileptic Drugs for Bipolar Disorder and the Risk of Suicidal Behavior: A 30-Year Observational Study

Andrew C LEON, David A SOLOMON, Chunshan Li, Jess G FIEDOROWICZ, William H CORYELL, Jean ENDICOTT and Martin B KELLER

The American journal of psychiatry, Vol.169(3), pp.285-291

2012

DOI: 10.1176/appi.ajp.2011.11060948

PMCID: PMC3643204

PMID: 22193537

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Abstract

Objective: In 2009 the U.S. Food and Drug Administration issued a warning regarding suicidality and antiepileptic drugs based on meta-analyses of 199 randomized trials (over 43,000 subjects with different illnesses) of 11 antiepileptics. The present study examines the hypothesis that the three antiepileptics approved for bipolar disorder (carbamazepine, lamotrigine, and valproate) are associated with an elevated risk of suicide attempts and suicides. Method: A prospective observational study was conducted at five U.S. academic medical centers from 1978 to 2009. Analyses included 199 participants with bipolar disorder for whom 1,077 time intervals were classified as either exposed to an antiepileptic (carbamazepine, lamotrigine, or valproate) or not exposed to an antiepileptic, an antidepressant, or lithium during 30 years of follow-up. Results: Participants who had more severe manic symptoms were more likely to receive antiepileptic drugs. Mixed-effects grouped-time survival models revealed no elevation in risk of suicide attempt or suicide during periods when participants were receiving antiepileptics relative to periods when they were not (hazard ratio=0.93, 95% CI=0.45–1.92), controlling for demographic and clinical variables through propensity score matching. Conclusions: In this longitudinal observational study, the risk of suicide attempts or suicides was not associated with the antiepileptics approved for bipolar disorder.

Psychology. Psychoanalysis. Psychiatry

Adult and adolescent clinical studies

Psychopathology. Psychiatry

Mood disorders

Biological and medical sciences

Medical sciences

Suicide

Bipolar disorders

Details

Title: Subtitle: Antiepileptic Drugs for Bipolar Disorder and the Risk of Suicidal Behavior: A 30-Year Observational Study
Creators: Andrew C LEON - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
David A SOLOMON - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
Chunshan Li - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
Jess G FIEDOROWICZ - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
William H CORYELL - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
Jean ENDICOTT - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
Martin B KELLER - Departments of Psychiatry and of Public Health, Weill Cornell Medical College, New York, United States
Resource Type: Journal article
Publication Details: The American journal of psychiatry, Vol.169(3), pp.285-291
DOI: 10.1176/appi.ajp.2011.11060948
PMID: 22193537
PMCID: PMC3643204
NLM abbreviation: Am J Psychiatry
ISSN: 0002-953X
eISSN: 1535-7228
Publisher: American Psychiatric Association; Arlington, VA
Language: English
Date published: 2012
Academic Unit: Psychiatry; Epidemiology; Iowa Neuroscience Institute
Record Identifier: 9984065476302771

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