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Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database

Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database
Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database
Background: epilepsy is a serious condition which can profoundly affect an individual’s life. While there is some evidence to suggest an association between antidepressant use and epilepsy and seizures it is conflicting and not conclusive. Antidepressant prescribing is rising in the UK so it is important to quantify absolute risks with individual antidepressants to enable shared decision making with patients. In this study we assess and quantify the association between antidepressant treatment and the risk of epilepsy and seizures in a large cohort of patients diagnosed with depression aged between 20 and 64 years.

Methods: data on 238,963 patients with a diagnosis of depression aged 20 to 64 from 687 UK practices were extracted from the QResearch primary care database. We used Cox’s proportional hazards to analyse the time to the first recorded diagnosis of epilepsy/seizures, excluding patients with a prior history and estimated hazard ratios for antidepressant exposure adjusting for potential confounding variables.

Results: in the first 5 years of follow-up, 878 (0.37 %) patients had a first diagnosis of epilepsy/seizures with the hazard ratio (HR) significantly increased (P?<?0.01) for all antidepressant drug classes and for 8 of the 11 most commonly prescribed drugs. The highest risks (in the first 5 years) compared with no treatment were for trazodone (HR 5.41, 95 % confidence interval (CI) 3.05 to 9.61, number needed to harm (NNH) 65), lofepramine (HR 3.09, 95 % CI 1.73 to 5.50, NNH 138), venlafaxine (HR 2.84, 95 % CI 1.97 to 4.08, NNH 156) and combined antidepressant treatment (HR 2.73, 95 % CI 1.52 to 4.91, NNH 166).

Conclusions: risk of epilepsy/seizures is significantly increased for all classes of antidepressant. There is a need for individual risk-benefit assessments in patients being considered for antidepressant treatment, especially those with ongoing mild depression or with additional risk factors. Residual confounding and indication bias may influence our results, so confirmation may be required from additional studies
1471-244X
1-13
Hill, Trevor
7c347407-2cde-4145-9a38-6e4258af6982
Coupland, Carol
6efd69d5-8f84-45ac-9777-d4b07feeb2e2
Morriss, Richard
fb48ce6f-f557-4e5d-a309-5eb7f6ee6c2e
Arthur, Antony
90ae53fb-349a-445a-8527-a3bba857a2d7
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec
Hill, Trevor
7c347407-2cde-4145-9a38-6e4258af6982
Coupland, Carol
6efd69d5-8f84-45ac-9777-d4b07feeb2e2
Morriss, Richard
fb48ce6f-f557-4e5d-a309-5eb7f6ee6c2e
Arthur, Antony
90ae53fb-349a-445a-8527-a3bba857a2d7
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec

Hill, Trevor, Coupland, Carol, Morriss, Richard, Arthur, Antony, Moore, Michael and Hippisley-Cox, Julia (2015) Antidepressant use and risk of epilepsy and seizures in people aged 20 to 64 years: cohort study using a primary care database. BMC Psychiatry, 15 (315), 1-13. (doi:10.1186/s12888-015-0701-9).

Record type: Article

Abstract

Background: epilepsy is a serious condition which can profoundly affect an individual’s life. While there is some evidence to suggest an association between antidepressant use and epilepsy and seizures it is conflicting and not conclusive. Antidepressant prescribing is rising in the UK so it is important to quantify absolute risks with individual antidepressants to enable shared decision making with patients. In this study we assess and quantify the association between antidepressant treatment and the risk of epilepsy and seizures in a large cohort of patients diagnosed with depression aged between 20 and 64 years.

Methods: data on 238,963 patients with a diagnosis of depression aged 20 to 64 from 687 UK practices were extracted from the QResearch primary care database. We used Cox’s proportional hazards to analyse the time to the first recorded diagnosis of epilepsy/seizures, excluding patients with a prior history and estimated hazard ratios for antidepressant exposure adjusting for potential confounding variables.

Results: in the first 5 years of follow-up, 878 (0.37 %) patients had a first diagnosis of epilepsy/seizures with the hazard ratio (HR) significantly increased (P?<?0.01) for all antidepressant drug classes and for 8 of the 11 most commonly prescribed drugs. The highest risks (in the first 5 years) compared with no treatment were for trazodone (HR 5.41, 95 % confidence interval (CI) 3.05 to 9.61, number needed to harm (NNH) 65), lofepramine (HR 3.09, 95 % CI 1.73 to 5.50, NNH 138), venlafaxine (HR 2.84, 95 % CI 1.97 to 4.08, NNH 156) and combined antidepressant treatment (HR 2.73, 95 % CI 1.52 to 4.91, NNH 166).

Conclusions: risk of epilepsy/seizures is significantly increased for all classes of antidepressant. There is a need for individual risk-benefit assessments in patients being considered for antidepressant treatment, especially those with ongoing mild depression or with additional risk factors. Residual confounding and indication bias may influence our results, so confirmation may be required from additional studies

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Accepted/In Press date: 14 December 2015
Published date: 17 December 2015
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 388215
URI: http://eprints.soton.ac.uk/id/eprint/388215
ISSN: 1471-244X
PURE UUID: 1e44c126-2e1a-4221-973a-e2a2786c3abc
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 22 Feb 2016 11:28
Last modified: 15 Mar 2024 03:22

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Contributors

Author: Trevor Hill
Author: Carol Coupland
Author: Richard Morriss
Author: Antony Arthur
Author: Michael Moore ORCID iD
Author: Julia Hippisley-Cox

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