Psychiatric Outcomes in Patients with Trigeminal Neuralgia Treated with Anticonvulsants with or without Antidepressants: A Retrospective Cohort Study Using TriNetX

Authors

  • Ashley Deng Drexel University College of Medicine
  • Dr. Eduardo Espiridion

Keywords:

Trigeminal Neuralgia, chronic pain, antidepressant drug, anticonvulsant drug

Abstract

BACKGROUND: Trigeminal Neuralgia (TN) presents as intense, spastic craniofacial pain that arises from a variety of causes including trigeminal nerve root compression, disruption in channel conductance, or idiopathic reasons. The chronicity and intensity of the pain leads to psychological co-morbidities including depression and anxiety. Because there is no cure for TN, treatment includes interventions that manage symptoms.

METHODS: The data for this study was obtained from TriNetX, a multi-national collaborative health network spanning over 116 million patient records in the U.S. The data is de-identified, continuously updated, and provides a variety of data points including labs, diagnoses, medications, procedures, and demographics. IRB approval was not required. Data was queried using ICD-10 codes and NLM classification. All patients included in the study were diagnosed with Trigeminal Neuralgia (ICD-10 CM: G50). The study population was sorted into two cohorts. Cohort 1 was defined as patients diagnosed with TN (ICD-10 CM: G50) and prescribed anticonvulsants medication (VA: CN400) and antidepressant medication (ATC: N06A). Cohort 2 was defined as patients diagnosed with TN and prescribed anticonvulsants medication without antidepressant medication. The two cohorts were propensity scores matched on characteristics including sex, current age, age at index, race, and ethnicity. The psychiatric outcomes that were assessed were a diagnosis of ‘major depressive disorder, recurrent (ICD-10 CM:F33)’, ‘Anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders (ICD-10 CM:F40-F48)’, and ‘sleep disorders not due to a substance or known physiological condition (ICD-10 CM:F51).

RESULTS: After a 1:1 Propensity Score Match, each cohort comprised 21,252 patients. Post-matching, both cohorts showed a balanced profile: mean age of 60 years, 70% female representation, 71% non-Hispanic or Latino, and 70% white. Results indicate that patients with TN taking anticonvulsants and antidepressants had a higher risk and odds for development of depression (8.218 RR, 8.601 OR), anxiety (2.788 RR, 3.152 OR), and sleep disorder (4.45 RR, 4.568 OR) than their counterparts taking only anticonvulsants. Similarly, patients with TN taking both anticonvulsants and antidepressants demonstrated a markedly higher hazard ratio in depression (8.038 HR), anxiety (2.943 HR), and sleep disorder (4.231 HR) development compared to their counterparts only taking anticonvulsant. However, log-rank analysis did not show a statistical significance of time to development of depression (p=0.546), anxiety (p=0.259), and sleep disorder(p=0.101) between the two cohorts.

CONCLUSION: Our findings align with current literature on the reciprocal relationship between pain and psychiatric symptoms. In TN, anticonvulsants are often prescribed to address pain, while antidepressants are prescribed to address psychiatric side effects of the chronic craniofacial pain. However, interaction between antidepressants and anticonvulsants are complicated and may influence the pharmacokinetics and pharmacodynamics of each other.

Metrics

Metrics Loading ...

References

NA

Downloads

Published

2025-01-01

How to Cite

Ashley Deng, & Espiridion, E. (2025). Psychiatric Outcomes in Patients with Trigeminal Neuralgia Treated with Anticonvulsants with or without Antidepressants: A Retrospective Cohort Study Using TriNetX. International Journal of Medical Students, 12, S364. Retrieved from https://ijms.pitt.edu/IJMS/article/view/2837

Issue

Vol 12. (2024): Supplement 1

Section

Abstracts of the WCMSR

Categories

License

Copyright (c) 2024 Ashley Deng, Dr. Eduardo Espiridion

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
    2. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
    3. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
    4. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
    5. The Author represents and warrants that:
      1. the Work is the Author’s original work;
      2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
      3. the Work is not pending review or under consideration by another publisher;
      4. the Work has not previously been published;
      5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
      6. the Work contains no libel, invasion of privacy, or other unlawful matter.
    6. The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Enforcement of copyright

The IJMS takes the protection of copyright very seriously.

If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.

If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org

 

Infringing material

If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org