Papers

Antidepressants and suicide

^a Boston Collaborative Drug Surveillance Program, Boston University Medical Center, 11 Muzzey Street, Lexington, MA 02173, USA, ^b Orsett, Essex

Abstract

Objective: To estimate the rate and means of suicide among people taking 10 commonly prescribed antidepressant drugs: dothiepin, amitriptyline, clomipramine, imipramine, flupenthixol, lofepramine, mianserin, fluoxetine, doxepin, and trazodone.
Design: Open cohort study with a nested casecontrol analysis.
Setting: General practices in the United Kingdom that used VAMP computers to maintain their patient records from January 1988 to February 1993.
Subjects: 172598 people who had at least one prescription for one of the 10 antidepresssants during the study period.
Main outcome measure: Suicide confirmed by general practitioner or on death certificate, or both.
Results: 143 people committed suicide. The overall rate of suicide was estimated to be 8.5 per 10000 person years (95% confidence interval 7.2 to 10.0). Rates of suicide were higher in men than women (relative risk 2.8 (95% confidence interval 1.9 to 4.0)), people with a history of feeling suicidal (19.2 (9.5 to 38.7)), and people who had taken several different antidepressants (2.8 (1.8 to 4.3)). People who received high doses of antidepressants and those who had had a prescription in the 30 days before they committed suicide were also at higher risk than those who had received low doses and had had their prescriptions 30 or more days previously (2.3 (1.4 to 3.7) and 2.3 (1.6 to 3.4)) respectively. Rates of suicide were higher in patients who received fluoxetine, but this may be explained by selection biases which were present for those drug users.
Conclusion: Several factors correlate with the risk of suicide in people taking antidepressants. After controlling for these factors, the risk of suicide was similar among the 10 study antidepressants. Overdose with antidepressants accounted for only 14% of the suicides.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Venlafaxine for major depression

Andrea Cipriani, John R Geddes, and Corrado Barbui
BMJ 2007 334: 215-216. [Extract] [Full Text] [PDF]

Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study

Annalisa Rubino, Neil Roskell, Pat Tennis, Daniel Mines, Scott Weich, and Elizabeth Andrews
BMJ 2007 334: 242. [Abstract] [Full Text] [PDF]

Consent for the use of personal medical data in research

Peter Singleton and Michael Wadsworth
BMJ 2006 333: 255-258. [Full Text] [PDF]

Antidepressants and suicide: Authors' reply

David Gunnell and Deborah Ashby
BMJ 2004 329: 461-462. [Extract] [Full Text]

The two study groups may not be comparable

David Gunnell
BMJ 1995 311: 56. [Extract] [Full Text]

Antidepressants prescribed for conditions other than depression

A P Fletcher
BMJ 1995 311: 56-57. [Extract] [Full Text]

This article has been cited by other articles:

• Barbui, C. MD, Esposito, E. MD, Cipriani, A. MD (2009). Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies. CMAJ 180: 291-297 [Abstract] [Full text]  
• Gartlehner, G., Gaynes, B. N., Hansen, R. A., Thieda, P., DeVeaugh-Geiss, A., Krebs, E. E., Moore, C. G., Morgan, L., Lohr, K. N. (2008). Comparative Benefits and Harms of Second-Generation Antidepressants: Background Paper for the American College of Physicians. ANN INTERN MED 149: 734-750 [Abstract] [Full text]  
• Morgan, O., Griffiths, C., Majeed, A. (2008). Antidepressant prescribing and changes in antidepressant poisoning mortality and suicide in England, 1993-2004. J Public Health (Oxf) 30: 60-68 [Abstract] [Full text]  
• Morrato, E. H., Libby, A. M., Orton, H. D., deGruy, F. V. III, Brent, D. A., Allen, R., Valuck, R. J. (2008). Frequency of Provider Contact After FDA Advisory on Risk of Pediatric Suicidality With SSRIs. Am. J. Psychiatry 165: 42-50 [Abstract] [Full text]  
• Cipriani, A., Geddes, J. R, Barbui, C. (2007). Venlafaxine for major depression. BMJ 334: 215-216 [Full text]  
• Rubino, A., Roskell, N., Tennis, P., Mines, D., Weich, S., Andrews, E. (2007). Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study. BMJ 334: 242-242 [Abstract] [Full text]  
• Olfson, M., Marcus, S. C., Shaffer, D. (2006). Antidepressant drug therapy and suicide in severely depressed children and adults: a case-control study.. Arch Gen Psychiatry 63: 865-872 [Abstract] [Full text]  
• Singleton, P., Wadsworth, M. (2006). Consent for the use of personal medical data in research. BMJ 333: 255-258 [Full text]  
• Juurlink, D. N., Mamdani, M. M., Kopp, A., Redelmeier, D. A. (2006). The Risk of Suicide With Selective Serotonin Reuptake Inhibitors in the Elderly. Am. J. Psychiatry 163: 813-821 [Abstract] [Full text]  
• Caksen, H., Akbayram, S., Odabas, D., Ozbek, H., Erol, M., Akgun, C., Tuncer, O., Yilmaz, C. (2006). Acute amitriptyline intoxication: an analysis of 44 children. Hum Exp Toxicol 25: 107-110 [Abstract]  
• Simon, G. E., Savarino, J., Operskalski, B., Wang, P. S. (2006). Suicide Risk During Antidepressant Treatment. Am. J. Psychiatry 163: 41-47 [Abstract] [Full text]  
• Hansen, R. A., Gartlehner, G., Lohr, K. N., Gaynes, B. N., Carey, T. S. (2005). Efficacy and Safety of Second-Generation Antidepressants in the Treatment of Major Depressive Disorder. ANN INTERN MED 143: 415-426 [Abstract] [Full text]  
• Edwards, J. G. (2005). Newer v. older antidepressants in long-term pharmacotherapy: REVISITING... PREVENTION OF RELAPSE AND RECURRENCE OF DEPRESSION. Adv. Psychiatr. Treat. 11: 184-194 [Abstract] [Full text]  
• Gunnell, D., Saperia, J., Ashby, D. (2005). Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. BMJ 330: 385- [Abstract] [Full text]  
• Martinez, C., Rietbrock, S., Wise, L., Ashby, D., Chick, J., Moseley, J., Evans, S., Gunnell, D. (2005). Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study. BMJ 330: 389- [Abstract] [Full text]  
• Gunnell, D., Ashby, D. (2004). Antidepressants and suicide: Authors' reply. BMJ 329: 461-462 [Full text]  
• Jick, H., Kaye, J. A., Jick, S. S. (2004). Antidepressants and the Risk of Suicidal Behaviors. JAMA 292: 338-343 [Abstract] [Full text]  
• Gunnell, D., Ashby, D. (2004). Antidepressants and suicide: what is the balance of benefit and harm. BMJ 329: 34-38 [Full text]  
• Nutt, D. J. (2003). Death and Dependence: Current Controversies over the Selective Serotonin Reuptake Inhibitors. J Psychopharmacol 17: 355-364 [Abstract]  
• Yang, C.-C., Jick, S. S., Jick, H. (2003). Lipid-Lowering Drugs and the Risk of Depression and Suicidal Behavior. Arch Intern Med 163: 1926-1932 [Abstract] [Full text]  
• Hippisley-Cox, J., Pringle, M., Cater, R., Wynn, A., Hammersley, V., Coupland, C., Hapgood, R., Horsfield, P., Teasdale, S., Johnson, C. (2003). The electronic patient record in primary care--regression or progression? A cross sectional study. BMJ 326: 1439-1443 [Abstract] [Full text]  
• Healy, D. (2001). The dilemmas posed by new and fashionable treatments. Adv. Psychiatr. Treat. 7: 322-327 [Full text]  
• Whooley, M. A., Simon, G. E. (2000). Managing Depression in Medical Outpatients. NEJM 343: 1942-1950 [Full text]  
• DONOVAN, S., MADELEY, R., CLAYTON, A., BEEHARRY, M., JONES, S., KIRK, C., WATERS, K., GARDNER, D., FAULDING, J. (2000). Deliberate self-harm and antidepressant drugs: Investigation of a possible link. Br. J. Psychiatry 177: 551-556 [Abstract] [Full text]  
• Skegg, D. C G (2000). Pitfalls of pharmacoepidemiology. BMJ 321: 1171-1172 [Full text]  
• Williams, J. W. Jr., Mulrow, C. D., Chiquette, E., Noel, P. H., Aguilar, C., Cornell, J. (2000). A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary: Clinical Guideline, Part 2. ANN INTERN MED 132: 743-756 [Abstract] [Full text]  
• Leon, A. C., Keller, M. B., Warshaw, M. G., Mueller, T. I., Solomon, D. A., Coryell, W., Endicott, J. (1999). Prospective Study of Fluoxetine Treatment and Suicidal Behavior in Affectively Ill Subjects. Am. J. Psychiatry 156: 195-201 [Abstract] [Full text]  
• Healy, D., Langmaak, C., Savage, M. (1999). Suicide in the course of the treatment of depression. J Psychopharmacol 13: 94-99 [Abstract]  
• Rivara, F. P., Grossman, D. C., Cummings, P. (1997). Injury Prevention- Second of Two Parts. NEJM 337: 613-618 [Full text]  
• Whyte, I., Buckley, N., Carter, G. (1995). Antidepressants and suicide. BMJ 311: 55-55 [Full text]  
• Bernadt, M., Hammill, R. (1995). Study's conclusion is unwarranted. BMJ 311: 56-56 [Full text]  
• House, A., Sheldon, T., Freemantle, N. (1995). Study is based on unproved assumptions. BMJ 311: 55a-55 [Full text]  
• Gunnell, D. (1995). The two study groups may not be comparable. BMJ 311: 56a-56 [Full text]  
• Fletcher, A P (1995). Antidepressants prescribed for conditions other than depression. BMJ 311: 56b-57 [Full text]  
• Anderson, I M, Tomenson, B M (1995). Treatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis. BMJ 310: 1433-1438 [Abstract] [Full text]  
• (1995). Antidepressants and Suicide. JWatch Psychiatry 1995: 8-8 [Full text]  
• (1995). ANTIDEPRESSANTS AND SUICIDE RISK. JWatch General 1995: 3-3 [Full text]  
• Edwards, J G. (1995). Suicide and antidepressants. BMJ 310: 205-206 [Full text]