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Study calculates links between prescription medications and risk for suicide

November 6, 2019

There’s a saying that what doesn’t kill us makes us stronger—but that shouldn’t be true of the FDA-approved drugs prescribed to us by our doctors.

Nevertheless, a review by the Center for Health Statistics at the University of Chicago of 922 medications that had been prescribed to nearly 150 million Americans over an 11-year period recently found that just 10 of these drugs were associated with an increased rate of suicide attempts, the university reported on November 5 in a press release.

Conversely, 44 drugs were linked to a decrease in suicide attempts, including many that carry a “black box” label from the FDA warning of their association with suicidal behavior.

The study findings, published in the Harvard Data Science Review, identifiy several drugs with the potential to prevent suicide attempts that are not currently used for that purpose, including folic acid, a simple vitamin often prescribed to pregnant women.

“There’s an antihistamine that’s associated with decreases in suicide. There’s a Parkinson’s drug associated with decreases,” said Robert Gibbons, PhD, the director of the center and lead author of the study. “If those test out in clinical trials to be real effects, we could be using more of these drugs to treat suicidal people.”

Suicide is now the tenth leading cause of death in the United States, according to the National Institute of Mental Health. Most suicides occur in patients with a psychiatric disorder, such as depression. However, common antidepressant medications such as fluoxetine (Prozac) carry the FDA’s black box warnin— which has led to decreased use of these medications, despite the benefits they might provide.

For the new study, Gibbons and his team developed a statistical tool to measure the links between drugs and suicide attempts. They analyzed data on 922 drugs with more than 3,000 prescriptions in a database of medical claims from 2003 to 2014. The data contained records of 146 million unique patients from more than 100 health insurers in the United States. For each person taking each drug, they counted suicide attempts in the three months prior to filling the prescription and the three months after taking the drug. This approach allowed them to evaluate each drug individually within a single person and see its effect on suicide attempts.

“It’s actually a very simple model that answers the question, ‘Does a suicide attempt occur more frequently after taking the drug than before?'” Gibbons said.=

That analysis found 10 drugs that showed a statistically significant increase in suicide attempts-among them, the opioid painkiller hydrocodone bitartrate and acetaminophen (Vicodin); anti-anxiety drugs alprazolam (Xanax) and diazepam (Valium); and prednisone, a corticosteroid.

 A total of 44 drugs showed a decrease in suicide risk, including a large group of antidepressants with black box warnings like fluoxetine and escitalopram (Lexapro), gabapentin (Neurontin), an anti-convulsant used to treat seizures, and, interestingly, the vitamin folic acid.

Gibbons said the statistical model can be used to calculate the risk of any adverse events that happen before and after taking a medication. The Veterans Administration already has expressed interest in using the tool, and Gibbons hopes other large hospital systems and local health agencies will adopt it to help decide which drugs to prescribe, especially for patients at risk of suicide.

“What we’ve done is come up with an alternative approach to drug safety surveillance that could be used by any agency, country or formulary,” he said. ”

Research contact: @UChicago