The Effects of Co-Prescribing Anti-Epileptic Drugs and Antidepressant Medications among African Americans with Epilepsy at Grady Hospital: A Case-Crossover Study Public

Abstract

Background: People with epilepsy are likely to experience comorbid depression. To treat comorbid epilepsy and depression, patients are co-prescribed anti-epileptic drugs (AEDs) and antidepressants, which increases the risk for drug-drug interactions.

Methods:Data were obtained from medical records of African American adults with an epilepsy diagnosis who sought services at Grady Hospital. 126 patients were included in the analytic data sample who had a seizure event between 2010-2015, were prescribed an AED, and visited Grady Hospital every 90 days. A case-crossover study design was used to assess the effects of the co-prescription of antidepressants with AEDs on seizure activity. Analyses involved two generalized estimating equations (GEE) with different time periods for antidepressant medication use: 3 months and 6 weeks.

Results: Overall, nearly half of the patients were male (48%), and the majority were single (62%) with a mean age of 48 years (SD=16.5). In this sample, there is a low proportion of patients who are prescribed antidepressants (5%). The results of the GEE model suggest that the odds of having a seizure are nearly half for patients who have been co-prescribed an antidepressant with an AED for 6 weeks (OR=0.44; 95%CI: 0.42, 0.45) after adjusting for age, gender, and marital status. The odds of seizure activity further decrease for those who have been co-prescribed the medications for 3 months (OR=0.39; 95%CI: 0.38, 0.40). 

Conclusions: Antidepressants, when co-prescribed with AEDs, may have a protective effect on seizure activity. These results present opportunities for future research and interventions to reduce seizure frequency.

Table of Contents

TABLE OF CONTENTS

Abstract…………………………………………………………………………….……..3

Acknowledgments……………………………………………………………….............6

Introduction………………………………………………………………………............8

Literature Review………………………………………………………………………12

            Major Depression Disorder Prevalence in People with Epilepsy…………..........12

            Epilepsy Treatment ……………………………………………………………...13

            Pharmacokinetics and Pharmacodynamics………………………………………13

            Pharmacokinetics of Antiepileptic Drugs…………………………………..........14

            Pharmacologic Therapies for Major Depression Disorder………………………15

            Pharmacokinetics of Antidepressants……………………………………………15

            Drug-Drug Interactions between Antiepileptic Drugs and Antidepressants..........16

            Pharmacokinetic Drug-Drug Interactions………………………………………..16

            Pharmacodynamic Drug-Drug Interactions……………………………………...17

            Pharmacokinetic Drug-Drug Interactions between AEDs and Antidepressants…18

            Pharmacodynamic Drug-Drug Interactions between AEDs and Antidepressants.19

            Health Disparities………………………………………………………………...20

            Theoretical Model………………………………………………………………..20

Methods………………………………………………………………………………….23

            Participants……………………………………………………………………….23

                        Study Site………………………………………………………………...23

                        Sample Size………………………………………………………………23

                        Participant Selection……………………………………………………..25

                        Exclusion Criteria………………………………………………………..26

            Study Design……………………………………………………………………..26

            Measures…………………………………………………………………………29

                        Case and Control Time Periods………………………………………….29

                        Exposure…………………………………………………………………29

                        Antiepileptic Drugs……………………………………………………...29

                        Antidepressant Medications……………………………………………..31

                        Other Variables of Interest………………………………………………33

                        Recategorization of Variables…………………………………………...34

            Procedures……………………………………………………………………….34

                        Data Management……………………………………………………….34

                        Analytic Methods………………………………………………………..35

Results…………………………………………………………………………………..36

Discussion………………………………………………………………………………42

            Comparison with Other Research……………………………………………….42

            Limitations……………………………………………………………………....43

            Strengths…………………………………………………………………………43

            PRECEDE-PROCEED Model Implications…………………………………….44

            Public Health Implications………………………………………………………46

Conclusion………………………………………………………………………………48

References………………………………………………………………………………49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Pharmacology Health Sciences, Mental Health Health Sciences, Epidemiology
Mot-clé	Seizure Drug Interactions Antiepileptic drugs Epilepsy Pharmacology Depression Antidepressants
Committee Chair / Thesis Advisor	Thompson, Nancy J, Emory University
Committee Members	Lash, Timothy L, Emory University Simard, Edgar P, Glaxo Smith Kline Haardoerfer, Regine, Emory University
Partnering Agencies	Hospital or other health care provider

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