Medications and Suicide: High Dimensional Empirical Bayes Screening (iDEAS)

Gibbons, Robert V.; Hur, Kwan; Lavigne, Jill; Wang, Jiebiao; Mann, J. John

doi:10.1162/99608f92.6fdaa9de

Cited by 13 publications

(36 citation statements)

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“…This corresponds with prior epidemiological studies that have found these medications to be associated with reduced risk of suicidal behavior in substance use disorders (35), and in released prisoners (36). These drugs were also found to be associated with statistically significantly reduced risks in the screening study by Gibbons et al (15). Addiction disorders are highly correlated with suicidal behavior (37).…”

Section: Discussionsupporting

confidence: 86%

“…Both are benzodiazepines (alprazolam, IRR = 1.39; and flunitrazepam, IRR = 1.83). Alprazolam was found to be the drug associated with the greatest risk increase in the screening study by Gibbons et al (15). Findings that benzodiazepines carry risks to patients have led to de-registrations or restrictions of the use of these drugs in several markets.…”

Section: Discussionmentioning

confidence: 99%

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Use of central nervous system drugs in combination with selective serotonin reuptake inhibitor treatment: A Bayesian screening study for risk of suicidal behavior

et al. 2022

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BackgroundUsing other central nervous system (CNS) medications in combination with selective serotonin reuptake inhibitor (SSRI) treatment is common. Despite this, there is limited evidence on the impact on suicidal behavior of combining specific medications. We aim to provide evidence on signals for suicidal behavior risk when initiating CNS drugs during and outside of SSRI treatment.Materials and methodsUsing a linkage of Swedish national registers, we identified a national cohort of SSRI users aged 6–59 years residing in Sweden 2006–2013. We used a two-stage Bayesian Poisson model to estimate the incidence rate ratio (IRR) of suicidal behavior in periods up to 90 days before and after a CNS drug initiation during SSRI treatment, while accounting for multiple testing. For comparison, and to assess whether there were interactions between SSRIs and other CNS drugs, we also estimated the IRR of initiating the CNS drug without SSRI treatment.ResultsWe identified 53 common CNS drugs initiated during SSRI treatment, dispensed to 262,721 individuals. We found 20 CNS drugs with statistically significant IRRs. Of these, two showed a greater risk of suicidal behavior after versus before initiating the CNS drug (alprazolam, IRR = 1.39; flunitrazepam, IRR = 1.83). We found several novel signals of drugs that were statistically significantly associated with a reduction in the suicidal behavior risk. We did not find evidence of harmful interactions between SSRIs and the selected CNS drugs.ConclusionSeveral of the detected signals for reduced risk correspond to drugs where there is previous evidence of benefit for antidepressant augmentation (e.g., olanzapine, quetiapine, lithium, buspirone, and mirtazapine). Novel signals of reduced suicidal behavior risk, including for lamotrigine, valproic acid, risperidone, and melatonin, warrant further investigation.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Use of central nervous system drugs in combination with selective serotonin reuptake inhibitor treatment: A Bayesian screening study for risk of suicidal behavior

et al. 2022

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“…Development of new statistical methods to support these systems grew post‐9/11 to support early detection of bioterrorism events or epidemics. (Behrman et al., 2011; Gibbons, Hur, Lavigne, Bae, & Mann, 2020; Psaty & Breckenridge, 2014; Wang et al., 2019) Most recently, these methods were applied to identify potential drug targets for suicide prevention as well as medications associated with unexpected rates of suicide attempts (Gibbons et al., 2020). This new statistical system, iDEAS (Gibbons et al., 2020), applied high dimensional empirical Bayes theorem to simultaneously analyze hundreds of different exposures for unexpected increases or decreases in rates of rare events, controlling for age and sex.…”

Section: Measurement Of Suicidal Behavior and Covariates In Rwdmentioning

confidence: 99%

“…(Behrman et al., 2011; Gibbons, Hur, Lavigne, Bae, & Mann, 2020; Psaty & Breckenridge, 2014; Wang et al., 2019) Most recently, these methods were applied to identify potential drug targets for suicide prevention as well as medications associated with unexpected rates of suicide attempts (Gibbons et al., 2020). This new statistical system, iDEAS (Gibbons et al., 2020), applied high dimensional empirical Bayes theorem to simultaneously analyze hundreds of different exposures for unexpected increases or decreases in rates of rare events, controlling for age and sex. iDEAS scanned 150 million North Americans’ longitudinal inpatient, outpatient, and prescription drug claims scanned about 900 medications filled by patients for the first time and compared suicide attempt rates (as recorded in emergency rooms or inpatient admissions) before and after the new drug exposure.…”

Section: Measurement Of Suicidal Behavior and Covariates In Rwdmentioning

confidence: 99%

Study designs and statistical approaches to suicide and prevention research in real‐world data

Lavigne

Lagerberg

Ambrosi

et al. 2021

Suicide & Life Threat Behav

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ObjectiveTo provide researchers, clinicians and policy makers with a primer to study designs, statistical approaches and graphical reporting methods for suicide research in real world data (RWD).MethodsStudy designs, statistical method and graphical reporting standards are detailed with examples from the recently published literature.ResultsData sources and codes for identifying suicidal behavior are described. Study designs are described in detail for post‐market surveillance, retrospective cohort studies, case control and nested case–control studies, and self‐controlled (within‐individual) studies including applications of marginal structural models. Graphical reporting of designs is described using an original research study.ConclusionsCompared to RCTs, RWE studies offer larger sample sizes, greater generalizability, and real‐world validity. However, these non‐experimental data risk uncontrolled confounding and potential introduction of bias unless data, design and statistical approaches are rigorously aligned.

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“… 20 , 21 Treatments including anti-anxiety medications and opioid-based analgesics have been associated with an increased suicide risk in certain patients, although caution should be exercised when examining associations and drawing conclusions about causality from observational data. 22 Thus, suicide screening is important for all patients receiving treatment with antidepressant therapy, and assessment of suicidal ideation and behaviors should be a routine part of treatment monitoring. 4 , 18 Of note, denial of suicidal ideation would appear to be more common than previously acknowledged, thus presenting a formidable challenge for clinicians, since denial, by itself, is an inadequate indicator of suicide risk.…”

Section: Introductionmentioning

confidence: 99%

Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD)

Montano¹,

Jackson²,

Vanacore³

et al. 2022

NDT

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Primary care clinicians have a vital role to play in the diagnosis and management of patients with major depressive disorder (MDD). This includes screening for MDD as well as identifying other possible psychiatric disorders including bipolar disorder and/or other comorbidities. Once MDD is confirmed, partnering with patients in the shared decision-making process while considering different treatment options and best management of MDD over the course of their illness is recommended. Vortioxetine has been approved for the treatment of adults with MDD since 2013, and subsequent US label updates indicate that vortioxetine may be particularly beneficial for specific populations of patients with MDD, including those with treatment-emergent sexual dysfunction and patients experiencing certain cognitive symptoms. Given these recent label updates, this prescribing guide for vortioxetine aims to provide clear and practical guidance for primary care clinicians on the safe and effective use of vortioxetine for the treatment of MDD, including how to identify appropriate patients for treatment.

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Medications and Suicide: High Dimensional Empirical Bayes Screening (iDEAS)

Cited by 13 publications

References 0 publications

Use of central nervous system drugs in combination with selective serotonin reuptake inhibitor treatment: A Bayesian screening study for risk of suicidal behavior

Use of central nervous system drugs in combination with selective serotonin reuptake inhibitor treatment: A Bayesian screening study for risk of suicidal behavior

Study designs and statistical approaches to suicide and prevention research in real‐world data

Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD)

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