Antidepressants and suicide: Authors' reply

doi:10.1136/bmj.329.7463.461-b

BMJ 2004;329:461-462 (21 August), doi:10.1136/bmj.329.7463.461-b

Letter

Antidepressants and suicide

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—We agree with Aldred and Healy's suggestion thatpart of the recent rise in antidepressant prescribing may bedue to there being a growing number of long term users of thesedrugs—we acknowledged this as a limitation of our model.If any adverse effects of antidepressants on suicide risk occurmainly in the first few weeks of treatment then our model willoverestimate these.

Mitchell correctly identifies that one of the major assumptionswe made in our model was that the risk estimates of non-fatalsuicidal behaviour derived from paediatric trials could be appliedto fatal suicidal behaviour in adults. We acknowledged thisimportant limitation of our modelled "worst case scenario" inthe paper. Mitchell points out the drug specific risk estimateswe reported in the table are risk ratios rather than odds ratios.The odds ratios for the drug specific estimates are very similarto the relative . . . [Full text of this article]

David Gunnell, professor of epidemiology

D.J.Gunnell@bristol.ac.uk Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Deborah Ashby, professor of medical statistics

Wolfson Institute of Preventive Medicine, Barts and London, Queen Mary School of Medicine and Dentistry, University of London, London EC1M 6BQ