Association of Suicide Attempts with Gabapentinoid treatment

Background: Previous studies have suggested an association between gabapentinoids and an increased risk of suicide. However, it remains unclear whether the increased risk is attributable to the underlying conditions for which gabapentinoids are prescribed or the influence of other concurrent medications.

Objectives: To investigate the association between gabapentinoids use and the risk of suicide attempt.

Methods: A population-based study utilising data from the UK Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics (HES) was conducted. Individuals aged 18 years or older who had received at least one prescription of gabapentinoids and at least one hospitalisation record of suicide attempt between January 1, 2000, and December 31, 2020 were included in the study. A self-controlled case series design was employed to control for time-invariant factors. The incidence rate ratio (IRR) of suicide attempt during periods when patients were exposed to gabapentinoid were compared with nonexposed periods. Time-varying confounders such as age, season, and concomitant use of opioids and psychotropic medications were adjusted in the conditional Poisson regression model.

Results: A total of 10,002 patients who had at least one episode of suicide attempt were included in the analysis. The mean age at baseline was 39.01 years, and 6,655 (66.54%) of these individuals were female. The overall incidence of suicide attempt during gabapentinoid treatment was 2.86 per 1,000 patient-years. No increased risk of suicide attempt was identified during the exposed period (IRR, 1.06; 95% CI, 0.98-1.13) compared with the nonexposed periods. An increased risk of suicide attempt was founded during the 90-day period before (IRR, 1.69; 95% CI, 1.55-1.85) gabapentinoid was initiated and the 14-day period after gabapentinoid was stopped (IRR, 3.02; 95% CI, 2.53-3.60). The trends remained consistent across age groups, sex, ethnicity groups and types of gabapentinoids.

Conclusions: Our study findings suggest that no increased risk of suicide attempt during gabapentinod exposed period. Considering the growing use of gabapentinoids globally, additional real-world studies of various outcomes are warranted to ensure safe use in the wider population.