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

Background:  

Trigeminal Neuralgia (TN) presents as an intense, spastic cranio-facial pain stemming from trigeminal nerve root compression, disruption in channel conductance, or idiopathic causes. The chronicity and intensity of pain lead to psychological and physiological comorbidities including depression, anxiety, and sleep disturbances(Wu, 2015). 

Methods:

Data was obtained from TriNetX, a multi-national collaborative health network. De-identified and continuously updated data were queried from ICD-10 codes and NLM classification. IRB approval was not required. The retrospective cohort study was sorted into two cohorts. Cohort 1 was defined as patients diagnosed with TN prescribed both anticonvulsant and antidepressant medication. Cohort 2 was defined as patients diagnosed with TN prescribed anticonvulsants without antidepressant medication. Propensity score matching (PSM) was used on the two cohorts based on sex, age at index, race, and ethnicity. Psychiatric outcomes assessed were from the following diagnoses:‘major depressive disorder, recurrent’, ‘Anxiety, dissociative, stress-related,somatoform and other non psychotic mental disorders’, and ‘sleep disorders not due to a substance or known physiological condition.’ Measures of association and survival were assessed using the TriNetX platform, excluding patients diagnosed with the studied outcomes before the indexed event.

Results:   

After PSM, each cohort comprised 21,252 patients with a balanced profile: mean age of 60 years, 70% female representation, 71% non-Hispanic or Latino, and 70% white. Results indicated TN patients  taking anticonvulsants and antidepressants had a higher risk, odds, and hazard ratio for development of depression (8.218 RR, 8.601 OR, 8.038 HR), anxiety (2.788 RR, 3.152 OR, 2.943 HR), and sleep disorders (4.45 RR, 4.568 OR, 4.231 HR) compared to those  taking only anticonvulsants. However, log-rank analysis did not show a statistical significance (p< 0.05) of time to development of depression (p=0.546), anxiety (p=0.259), and sleep disorders (p=0.101) between the two cohorts.

Discussion:   

Our findings align with current literature on the reciprocal relationship between chronic pain and psychiatric symptoms (Vadivelu, 2017). TN patients primarily receive anticonvulsants to address pain, with antidepressants given to further modulate chronic cranio-facial pain and address psychiatric side effects (Lee, 2023). However, the intricate interplay between antidepressants and anticonvulsants can significantly impact their individual pharmacokinetics and pharmacodynamics, given the existing anatomical and neuro-chemical overlap

Conclusion:  

The treatment for TN should adopt a multi-modal strategy to address both pain and psychiatric symptoms. Concurrent prescription of anticonvulsants and antidepressants might worsen psychiatric outcomes. Additional studies on dosage and prospective cohorts are necessary. 

References:  

Wu TH, Hu LY, Lu T, et al. Risk of psychiatric disorders following trigeminal neuralgia: a nationwide population-based retrospective cohort study. J Headache Pain. 2015;16:64. doi:10.1186/s10194-015-0548-y

Vadivelu N, Kai AM, Kodumudi G, Babayan K, Fontes M, Burg MM. Pain and Psychology—A Reciprocal Relationship. Ochsner J. 2017;17(2):173-180.

Lee, Jin Young et al. “Non-Surgical Treatments of Trigeminal Neuralgia from the Perspective of a Pain Physician: A Narrative Review.” Biomedicines vol. 11,8 2315. 21 Aug. 2023, doi:10.3390/biomedicines11082315




Presentation Eligibility: Not previously published or presented

Diversity, Equity, and Inclusion: This study comprised a study population of 70% female, a population that is traditionally under-respresetned in research, but also the most disproportionately affected by chronic pain.
We utilized a novel database, TriNetX, that harnesses medical and sociodemographic data across global healthcare organizations to advance research and therapy development. This reduces the barriers of access to de-identified patient data which creates more opportunity for clinical research, investigating health disparities, and increasing diversity in recruitment for clinical trials.
Further, this submission is led by medical students, enhancing representation of a population not traditionally promoted as lead authors in research.