In a study of just over 10,000 adult patients, researchers found that the risk of self-harm increased in the 90 days before patients started gabapentinoids and spiked again shortly after they stopped treatment. In contrast, the risk declined during the treatment period itself.
The investigators used UK health data to examine how self-harm risk varies around gabapentinoid use. Gabapentin and pregabalin are commonly prescribed for epilepsy, nerve pain, and anxiety, but are also widely used off-label for other conditions.
The researchers analyzed 10,002 adults who received a gabapentinoid prescription and had an incident self-harm event between 2000 and 2020. In the 90 days before patients started the medication, the self-harm rate was 16.79 per 100 person-years. During treatment, it declined to 9.66, but rose to 29.60 in the 14 days following treatment cessation. The reference period—when patients were not exposed to the drug—had a lower rate of 6.75.
Following adjustments for age, season, and concurrent medications, investigators found the risk of self-harm was 69% higher in the 90 days prior to treatment and three times higher in the 2 weeks after stopping it, compared with the reference period. Risk during the treatment phase was not statistically different from baseline.
“The findings remained consistent throughout a series of subgroups and sensitivity analyses,” wrote Andrew S C Yuen, a doctoral student at the Research Department of Practice and Policy, School of Pharmacy, University College London, with colleagues.
In further analyses, men showed a higher increase in self-harm risk after stopping the drug than women, and patients who were prescribed pregabalin had a slightly higher risk of self-harm than those on gabapentin, though the difference was not statistically significant.
Nearly 90% of participants had a diagnosis of depression, anxiety, insomnia, or another psychiatric condition. Most had been prescribed psychotropic medications, including antidepressants and opioids, prior to their self-harm event.
Investigators noted that the elevated self-harm risk prior to treatment may reflect the severity of the condition(s) that prompt the prescription. The spike in risk following discontinuation may relate to changes in mental health or withdrawal effects.
The study did not establish a direct causal link between gabapentinoid use and self-harm. However, the study authors concluded, "these findings underscore the necessity for close patient monitoring of self-harm throughout the gabapentinoid treatment journey."
Full disclosures can be found in the study.
Source: The BMJ
