scholarly journals Antiepileptic drugs and suicide-related outcomes in bipolar disorder: A descriptive review of published data

2018 ◽  
Vol 8 (3) ◽  
pp. 138-147 ◽  
Author(s):  
Charles F. Caley ◽  
Emily Perriello ◽  
Julia Golden
Keyword(s):  
Bipolar Disorder ◽  
Antiepileptic Drugs ◽  
Suicide Attempts ◽  
Reference Group ◽  
Lithium Treatment ◽  
Reporting Rate ◽  
Published Data ◽  
Suicide Death ◽  
Suicidal Thinking ◽  
Increased Risk

Abstract Introduction: In January 2008 the US Food and Drug Administration issued a warning to healthcare professionals about the potential for an increased risk of suicidal thinking and behavior associated with antiepileptic drugs (AEDs). Given that AEDs are important for treating bipolar disorder (BD), a better understanding of suicide-related events is necessary. Methods: A PubMed search was performed using the following search terms: anticonvulsant OR valpro* OR carbamazepine OR lamotrigine OR oxcarbazepine OR topiramate AND bipolar AND suicid*. The objective was to identify published investigations reporting rate and/or risk data of suicide-related outcomes in BD patients treated with AED monotherapy. Results: The search identified 323 reviewable citations, with 13 of these studies (4.0%) being reviewed. Valproate was studied most often, and lithium treatment was frequently used as a reference group. Carbamazepine and lamotrigine had small treatment exposure durations. Suicide attempts and suicide deaths were studied the most; a few trials investigated suicidal thinking and/or hospitalizations for suicidal behavior. Suicide attempt rates occurred in the following order: no treatment > carbamazepine > valproate > lithium, while suicide death rates were: no treatment > valproate > lithium > carbamazepine. For valproate, the risk of suicide attempts and suicide death appeared higher than lithium, but lower than no treatment. Discussion: Investigating suicide-related events for AEDs in BD is difficult; more data are necessary for valproate, carbamazepine, and lamotrigine. An improved understanding of AED treatment and suicide-related events in BD may help pharmacists become more effective at supporting their patients with BD.

scholarly journals Risks of 23 specific malformations associated with prenatal exposure to 10 antiepileptic drugs

Neurology ◽  
2019 ◽  
Vol 93 (2) ◽  
pp. e167-e180 ◽  
Author(s):  
Pierre-Olivier Blotière ◽  
Fanny Raguideau ◽  
Alain Weill ◽  
Elisabeth Elefant ◽  
Isabelle Perthus ◽  
...  
Keyword(s):  
Health Care ◽  
Valproic Acid ◽  
Antiepileptic Drugs ◽  
Congenital Malformations ◽  
Cleft Lip ◽  
Reference Group ◽  
The Other ◽  
Increased Risk ◽  
Exact Confidence Intervals ◽  
Major Congenital Malformations

ObjectiveTo assess the association between exposure to monotherapy with 10 different antiepileptic drugs (AEDs) during the first 2 months of pregnancy and the risk of 23 major congenital malformations (MCMs).MethodsThis nationwide cohort study, based on the French health care databases, included all pregnancies ≥20 weeks and ending between January 2011 and March 2015. Women were considered to be exposed when an AED had been dispensed between 1 month before and 2 months after the beginning of pregnancy. The reference group included pregnant women with no reimbursement for AEDs. MCMs were detected up to 12 months after birth (24 months for microcephaly, hypospadias, and epispadias). Odds ratios (ORs) were adjusted for potential confounders for MCMs with at least 5 cases. Otherwise, we calculated crude ORs with exact confidence intervals (CIs).ResultsThe cohort included 1,886,825 pregnancies, 2,997 of which were exposed to lamotrigine, 1,671 to pregabalin, 980 to clonazepam, 913 to valproic acid, 579 to levetiracetam, 517 to topiramate, 512 to carbamazepine, 365 to gabapentin, 139 to oxcarbazepine, and 80 to phenobarbital. Exposure to valproic acid was associated with 8 specific types of MCMs (e.g., spina bifida, OR 19.4, 95% CI 8.6–43.5), and exposure to topiramate was associated with an increased risk of cleft lip (6.8, 95% CI 1.4–20.0). We identified 3 other signals. We found no significant association for lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, and gabapentin.ConclusionsThese results confirm the teratogenicity of valproic acid and topiramate. Because of the small numbers of cases and possible confounding, the other 3 signals should be interpreted with appropriate caution.

Antiepileptic Drugs and Suicide Attempts in Patients With Bipolar Disorder

2010 ◽  
Vol 67 (9) ◽  
pp. 972 ◽  
Author(s):  
Evelyn K. Mentari ◽  
Marc Stone ◽  
Tarek A. Hammad
Keyword(s):  
Bipolar Disorder ◽  
Antiepileptic Drugs ◽  
Suicide Attempts

The association of bullying with suicide ideation and attempt among adolescents with different dimensions of sexual orientation

2016 ◽  
Vol 33 (S1) ◽  
pp. S71-S71 ◽  
Author(s):  
R. Montoro ◽  
K. Igartua ◽  
B.D. Thombs
Keyword(s):  
Sexual Orientation ◽  
Suicidal Ideation ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Reference Group ◽  
Two Dimensions ◽  
Self Report ◽  
Same Sex ◽  
Sex Attraction ◽  
Increased Risk

IntroductionSexual minority youth are at increased risk for bullying and suicide, but they are heterogeneous in their sexual orientation dimensions (attraction, behavior and identity).ObjectiveTo compare the association of bullying and suicide parameters between (1) heterosexually identified students without same-sex attractions or behaviors (2) heterosexually identified students with same-sex attractions or behaviors and (3) non-heterosexually identified students.MethodsThe Quebec Youth Risk Behavior Survey was a self-report questionnaire given to 1852 students 14–18 years old.ResultsThe heterosexually identified students without same-sex attraction or behavior, and no bullying, was our reference group. When these students had bullying, the likelihood of suicidal ideation was double, but their likelihood of suicide attempts was the same. For non-heterosexually identified students, those with no bullying were twice as likely, and those with bullying were four times as likely to have suicidal ideation. When these students had no bullying, they were not more likely to have suicide attempts, but they were almost three times as likely when they had bullying. Heterosexually identified students with same-sex attraction or behavior were never more likely on any of the suicide measures.ConclusionThis study was the first to show that adolescents with a non-heterosexual identity will have a disproportionately greater likelihood in their suicide parameters when subject to bullying, than heterosexually identified students with or without same-sex attraction or behavior, suggesting that these latter two dimensions were non-contributory to suicide risk. The significance of identity as a predictor of suicidal ideation and behavior will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals The Use of Cannabis as a Predictor of Early Onset of Bipolar Disorder and Suicide Attempts

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Rafaela Torres Portugal Leite ◽  
Sarah de Oliveira Nogueira ◽  
João Paulo Rodrigues do Nascimento ◽  
Laisa Soares de Lima ◽  
Taís Bastos da Nóbrega ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Early Onset ◽  
Suicide Attempts ◽  
Age At Onset ◽  
Prognostic Significance ◽  
Manic Episode ◽  
Cannabis Use ◽  
Pubmed Database ◽  
Increased Risk ◽  
Bipolar Patients

Introduction. Bipolar disorder (BD) implies risk of suicide. The age at onset (AAO) of BD carries prognostic significance. Substance abuse may precede the onset of BD and cannabis is the most common illicit drug used. The main goal of this study is to review the association of cannabis use as a risk factor for early onset of BD and for suicide attempts.Materials and Methods. PubMed database was searched for articles using key words “bipolar disorder,” “suicide attempts,” “cannabis,” “marijuana,” “early age at onset,” and “early onset.”Results. The following percentages in bipolar patients were found: suicide attempts 3.6–42%; suicide attempts and substance use 5–60%; suicide attempts and cannabis use 15–42%. An early AAO was associated with cannabis misuse. The mean age of the first manic episode in individuals with and without BD and cannabis use disorder (CUD) was 19.5 and 25.1 years, respectively. The first depressive episode was at 18.5 and 24.4 years, respectively. Individuals misusing cannabis showed increased risk of suicide.Discussion. Cannabis use is associated with increased risk of suicide attempts and with early AAO. However, the effect of cannabis at the AAO and suicide attempts is not clear.

scholarly journals Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 543-543
Author(s):  
Benjamin Szymanski ◽  
Eileen Ahearn ◽  
Eric Smith ◽  
Jenefer Jedele ◽  
John McCarthy ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Health System ◽  
Lithium Treatment ◽  
Cox Proportional Hazards ◽  
Fiscal Year ◽  
Dementia Diagnosis ◽  
Medical Comorbidities ◽  
Dementia Incidence ◽  
Increased Risk

Abstract Older adults with bipolar disorder are at increased risk of developing dementia. The literature suggests lithium treatment may reduce the incidence of dementia. This study sought to inform clinical practice in the Veterans Affairs (VA) health system by estimating the effect of past year lithium receipt on dementia incidence among Veterans with bipolar disorder. Divalproex receipt was used as a comparison. Using VA medical records, 121,094 Veterans aged 50 and older with a diagnosis of bipolar disorder but no dementia diagnosis were identified in fiscal years 2005-2019. Follow-up continued until dementia diagnosis, 36 months from the index date, death, or the end of fiscal year 2020, whichever came first. 4347 (3.6%) were diagnosed with dementia during follow-up. Time-varying indicators of receipt of lithium and divalproex in the prior 365 days were calculated for each day, categorized as 301-365, 61-300, 1-60, or 0 days of receipt. Unadjusted Cox proportional hazards regression analyses indicated reduced dementia incidence with 301-365 (HR=0.86, 95% Confidence Interval [95%CI] 0.75-0.99) and 61-300 (HR=0.75, 95%CI 0.65-0.87) days of lithium receipt, compared to 0 days. For divalproex, 301-365 (HR=1.34, 95%CI 1.23-1.47) and 61-300 (HR=1.13, 95%CI 1.03-1.23) days of receipt were each associated with increased dementia incidence. Lithium effects were not statistically significant after adjusting for age, sex, race, ethnicity, medical comorbidities, and antidepressant, antipsychotic, and anxiolytic medication receipt. Divalproex effects remained statistically significant. Past year divalproex, but not lithium, receipt was significantly associated with dementia incidence among VA patients with bipolar disorder when adjusting for demographics and medical comorbidities.

Antiepileptic Drugs and Suicide Attempts in Patients With Bipolar Disorder—Reply

2010 ◽  
Vol 67 (12) ◽  
pp. 1326 ◽  
Author(s):  
Robert D. Gibbons ◽  
Kwan Hur ◽  
C. Hendricks Brown ◽  
J. John Mann
Keyword(s):  
Bipolar Disorder ◽  
Antiepileptic Drugs ◽  
Suicide Attempts

A Bayesian multilevel analysis of the longitudinal associations between relationship quality and suicidal ideation and attempts among youth with bipolar disorder

2020 ◽  
Author(s):  
Craig Sewall ◽  
Jeffrey M. Girard
Keyword(s):  
Bipolar Disorder ◽  
Risk Factor ◽  
Suicidal Ideation ◽  
Suicide Attempt ◽  
Relationship Quality ◽  
Suicide Attempts ◽  
Suicidal Thoughts ◽  
Increased Risk ◽  
Longitudinal Associations ◽  
Suicidal Thoughts And Behaviors

ABSTRACTBackground: Youth with bipolar disorder (BD) are at high risk for suicidal thoughts and behaviors and frequently experience interpersonal impairment, which is a risk factor for suicide. Yet, no study to date has examined the longitudinal associations between relationship quality in family/peer domains and suicidal thoughts and behaviors among youth with BD. Thus, we investigated how between-person differences--reflecting the average relationship quality across time--and within-person changes, reflecting recent fluctuations in relationship quality, act as distal and/or proximal risk factors for suicidal ideation (SI) and suicide attempts. Methods: We used longitudinal data from the Course and Outcome of Bipolar Youth Study (N=413). Relationship quality variables were decomposed into stable (i.e. average) and varying (i.e. recent) components and entered, along with major clinical covariates, into separate Bayesian multilevel models predicting SI and suicide attempt. We also examined how the relationship quality effects interacted with age and sex. Results: Poorer average relationship quality with parents (β= -0.33, 95% Bayesian Highest Density Interval (HDI) [-0.54, -0.11]) or friends (β= -0.33, 95% HDI [-0.55, -0.11]) were longitudinally associated with increased risk of SI but not suicide attempt. Worsening recent relationship quality with parents (β= -0.10, 95% HDI [-0.19, -0.03]) and, to a lesser extent, friends (β= -0.06, 95% HDI [-0.15, 0.03]), were also longitudinally associated with increased risk of SI. Worsening recent relationship quality with parents may also be associated with increased risk of suicide attempt (β= -0.13, 95% HDI [-0.29, 0.03]). The effects of certain relationship quality variables were moderated by gender but not age. Conclusions: Among youth with BD, having poorer average relationship quality with peers and/or parents represents a distal risk factor for SI but not suicide attempts. Additionally, worsening recent relationship quality with parents that is may be a time-sensitive indicator of increased risk for SI or suicide attempt.

scholarly journals Comorbid medical illness in bipolar disorder

2014 ◽  
Vol 205 (6) ◽  
pp. 465-472 ◽  
Author(s):  
Liz Forty ◽  
Anna Ulanova ◽  
Lisa Jones ◽  
Ian Jones ◽  
Katherine Gordon-Smith ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Mental Health Disorder ◽  
Acute Onset ◽  
Medical Illness ◽  
Illness Burden ◽  
Increased Risk ◽  
History Of ◽  
Dsm Iv ◽  
The Uk

BackgroundIndividuals with a mental health disorder appear to be at increased risk of medical illness.AimsTo examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden.MethodParticipants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria.ResultsWe found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset.ConclusionsBipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role.Declarations of interestNone.

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