Psychiatric Outcomes in Patients with Trigeminal Neuralgia Treated with Anticonvulsants and Antidepressants: A Retrospective Cohort Study Using a National Database

Authors

DOI:

https://doi.org/10.5195/ijms.2025.2726

Keywords:

Trigeminal Neuralgia, Chronic Pain, Depression, Anxiety, Sleep Disorders

Abstract

Background: Trigeminal Neuralgia (TN) is a chronic craniofacial condition characterized by intense, sporadic shocks of pain through the trigeminal nerve. The unpredictable and severe nature of these episodes can be physically and mentally debilitating, significantly affecting the quality of life and often leading to anxiety, depression, and sleep disorders. This study investigated the psychiatric outcomes of anxiety, depression, and sleep disorders in TN patients who were treated with both anticonvulsants and antidepressants, compared to those who were treated only with anticonvulsants, to explore a multi-modal approach for addressing both pain and psychiatric symptoms.

Methods: A retrospective analysis of electronic health records was conducted using TriNetX, a collaborative health network encompassing over 250 million patient records worldwide. The analysis included 15,129 patient records, comparing two cohorts of TN patients.

Results: After adjusting for demographic factors, both cohorts were predominately female (73%), white (70%), and about 59 years of age. The results indicated that patients taking both anticonvulsants and antidepressants had higher risk, odds, and hazard ratios for developing depression (RR 10.448, OR 10.906, HR 10.763), anxiety (RR 2.680, OR 3.210, HR 3.013), and sleep disorders (RR 3.595, OR 3.696, HR 3.697) compared to those taking only anticonvulsants.

Conclusion: Despite limitations including inability to assess dosage and severity of pain, these findings suggest that concurrent use of anticonvulsants and antidepressants may exacerbate psychiatric symptoms in TN patients. However, these effects might improve with appropriate dosage adjustments, highlighting the need for including dosage adjustments and monitoring.

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References

National Institute of Dental and Craniofacial Research (NIDCR). Craniofacial pain conditions. NIDCR. Available from: https://www.nidcr.nih.gov/research/data-statistics/craniofacial-pain-conditions. Accessed 2024 Jun 28.

Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15(10):1013–28.

Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220–8.

Miki K, Mori K, Hagiwara S, Tachibana M, Chiba K, Maeda M. Trigeminal neuralgia caused by a persistent primitive trigeminal artery variant and superior cerebellar artery. NMC Case Rep J. 2019;6(4):101–3.

Wu TH, Hu LY, Lu T, Chen PM, Chen HJ, Shen CC, et al. Risk of psychiatric disorders following trigeminal neuralgia: a nationwide population-based retrospective cohort study. J Headache Pain. 2015;16:64.

Tampi RR, Tampi DJ, Balachandran S, et al. Antipsychotics, antidepressants, anticonvulsants, melatonin, and benzodiazepines for behavioral and psychological symptoms of dementia: a systematic review of meta-analyses. Curr Treat Options Psych. 2017;4(1):55–79.

Vigo DV, Baldessarini RJ. Anticonvulsants in the treatment of major depressive disorder: an overview. Harv Rev Psychiatry. 2009;17(4):231–41.

Prabhavalkar KS, Poovanpallil NB, Bhatt LK. Management of bipolar depression with lamotrigine: an antiepileptic mood stabilizer. Front Pharmacol. 2015;6.

Araya EI, Claudino RF, Piovesan EJ, Chichorro JG. Trigeminal neuralgia: basic and clinical aspects. Curr Neuropharmacol. 2020;18(2):109–19.

Ware K, Tillery E, Linder L. General pharmacokinetic/pharmacodynamic concepts of mood stabilizers in the treatment of bipolar disorder. Ment Health Clin. 2016;6(1):54–61.

Lawthom C, Didelot A, Coppola A, Aledo-Serrano Á, Fazekas B, Sainz-Fuertes R, et al. The impact of epilepsy and antiseizure medications on sleep: findings from a large European survey in adults with epilepsy and matched controls. Epilepsy Behav. 2023;148:109000.

Luo Y, Zhang Y, Hu X, Zhang L, Wang J, Hu D, et al. A research on quality of life score (QOLS) of patients with trigeminal neuralgia (TN). J Infect Public Health. 2019;12(5):690–4.

Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473–81.

Steiger A, Pawlowski M. Depression and sleep. Int J Mol Sci. 2019;20(3):607.

Huff T, Weisbrod LJ, Daly DT. Neuroanatomy, cranial nerve 5 (trigeminal). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK482283/.

Yang S, Chang MC. Chronic pain: structural and functional changes in brain structures and associated negative affective states. Int J Mol Sci. 2019;20(13):3130.

Surah A, Baranidharan G, Morley S. Chronic pain and depression. Contin Educ Anaesth Crit Care Pain. 2014;14(2):85–9.

Di Stefano G, Truini A, Cruccu G. Real-world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia. Eur J Pain. 2021;25(6):1229–35.

Punyawudho B, Cloyd JC, Leppik IE, Ramsay RE, Marino SE, Pennell PB, et al. Characterization of the time course of carbamazepine deinduction by an enzyme turnover model. Clin Pharmacokinet. 2009;48(5):313–9.

Afonso AS, Carnaval T, Cés SV. Combination therapy for neuropathic pain: a review of recent evidence. J Clin Med. 2021;10(16):3533.

Sohi G, Lao N, Caraceni A, et al. Nonopioid drug combinations for cancer pain: a systematic review. Pain Rep. 2022;7(2):e995.

Kaeley N, Kabi A, Bhatia R, Mohanty A. Carbamazepine-induced hyponatremia: a wakeup call. J Fam Med Prim Care. 2019;8(5):1786–8.

Lien YHH. Antidepressants and hyponatremia. Am J Med. 2018;131(1):7–8.

Bojdani E, Souza FD, Rajagopalan A, et al. Hyponatremia and psychiatric diseases. Weight Manag.

Sawant NS, Parkar SR, Rupani K, et al. Hyponatremia misdiagnosed as depression. Ann Indian Psychiatry. 2019;3(2):168.

Grunze A, Amann BL, Grunze H. Efficacy of carbamazepine and its derivatives in the treatment of bipolar disorder. Medicina (Kaunas). 2021;57(5):433.

Simon LV, Keenaghan M. Serotonin syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482377/.

Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013;13(4):533–40.

Rybakowski JK. Mood stabilizers of first and second generation. Brain Sci. 2023;13(5):741.

Pain O, Hodgson K, Trubetskoy V, Ripke S, Marshe VS, Adams MJ, et al. Identifying the common genetic basis of antidepressant response. Biol Psychiatry Glob Open Sci. 2021;2(2):115–26.

Scatter plot comparing the effect sizes (on a decimal scale) of risk ratio, odds ratio, and hazard ratio for sleep disorders, anxiety, and depression. Each condition is represented with three colored symbols, showing depression as having the highest effect size across all three measures.

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Published

2025-03-31

How to Cite

Deng, A., Kaneria, P., & Espiridion, E. (2025). Psychiatric Outcomes in Patients with Trigeminal Neuralgia Treated with Anticonvulsants and Antidepressants: A Retrospective Cohort Study Using a National Database. International Journal of Medical Students, 13(1), 52–59. https://doi.org/10.5195/ijms.2025.2726

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Vol. 13 No. 1 (2025)

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