Meds and Suicide Risk

Welcome back. Searching for appropriate blog topics, I review the highlights of about 500 new research papers every week. If I’m lucky, I’ll find one or two you might find of interest that aren’t too specialized, complex or already well covered by the media, and for which the full paper or adequate supporting information is available without paying a fee. 

There are also topics I choose not to report, like health breakthroughs that may not turn out to be breakthroughs or suicide other than as an outcome of gun research.

Suicide rate by state, 1999-2016 (from www.cdc.gov/vitalsigns/suicide/infographic.html#graphic1).

I hesitated before going with today’s topic, but suicide is now one of the top 10 causes of death in the U.S., its rate having increased by 25% between 1999 and 2016. Although most suicides are related to psychiatric disorders, the effect of medications is intensely debated.

Some prescription drugs
might increase or decrease
suicidal behavior (photo
from www.krcu.org/).

In a recently published study, research collaborators from the University of Chicago, University of Illinois at Chicago, St. John Fisher College, Carnegie Mellon University and Columbia University developed a statistical methodology for identifying drugs associated with increased and decreased risk of suicidal events. 

Linking Prescription Drugs with Suicide
The researchers applied generalized mixed-effects regression modeling in analyzing medical claims and records of over 150 million people from 2003 to 2014.

They examined the relationship between 922 drugs, with more than 3,000 prescriptions, and nearly 44,000 suicidal events (suicide attempts and intentional self-harm, including fatalities) using medical claims from more than 100 health insurers (from IBM’s MarketScan database).

Their statistical modeling is built around a comparison of the number of each patient’s suicide attempts during the three months before and three months after filling the prescription of each drug.

For example, alprazolam is used to treat anxiety and panic disorders. Of the 4,719,202 patients who were prescribed the drug between 2003 and 2014, 1,035 had a suicidal event in the three months before filling the prescription and 1,861 had a suicidal event in the three months after filling the prescription.

A Change in Suicidal Behavior
The researchers highlight the medications associated with increased and decreased suicidal events, and break down those results by gender and age, younger than 18 versus 18 and older. They also provide the results for all 922 medications in a supplement to their paper.

Of the 922 medications, ten were associated with higher risk of suicide events: two anti-anxiety drugs, alprazolam (Xanax) and diazepam (Valium); two opioid and analgesic/opioid narcotic mixtures, acetaminophen/hydrocodone bitartrate (Vicodin) and codeine phosphate/promethazine hydrochloride; the barbiturate-stimulant mixture acetaminophen/butalbital/caffeine; two muscle relaxants, cyclobenzaprine hydrochloride and carisoprodal; the steroid prednisone; the phenothiazine promethazine hydrochloride (for nausea and vomiting caused by anesthesia or surgery); and the antibiotic azithromycin.

Drugs associated with significantly increased suicide events, showing the number of suicide attempts pre- and post-exposure to the drug and the number of people taking the drug (table modified from table in hdsr.mitpress.mit.edu/pub/18lm7jrp).

On the plus side, 44 medications were associated with a decreased risk of suicidal behavior. That list includes a large group of FDA-approved antidepressants, antipsychotics, medications for alcohol/drug abuse treatment, mood stabilizers (including antiepileptics) used for bipolar illness and chronic pain, as well as ADHD, Parkinson’s and anti-hypertensive medications, and a beta blocker, proton-pump inhibitor, antihistamine and vitamin.

Among the potentially most protective of the 44 medications were folic acid (vitamin), mirtazapine (antidepressant), hydroxyzine (antihistamine), disulfiram (alcoholism) and naltrexone (alcohol or drug abuse).

Wrap Up
If you or someone you know has attempted suicide or self harm or experienced suicidal feelings, it would seem wise to review or share the tables provided in the paper, especially the table I’ve included.

The results might lead to a consultation with the medical provider or at least a pharmacist, and that’s a good thing. Thanks for stopping by.

P.S.
Suicide rate statistics:
www.cdc.gov/vitalsigns/suicide
www.cnn.com/2018/06/07/health/suicide-report-cdc/index.html
Study of medications and suicide in Harvard Data Science Review: hdsr.mitpress.mit.edu/pub/18lm7jrp
Article on study on EurekAlert! website: www.eurekalert.org/pub_releases/2019-11/uoc-scl110519.php