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

doi:10.1136/bmj.39041.445104.BE

BMJ, doi: 10.1136/bmj.39041.445104.BE, (Published 12 December 2006)

RESEARCH

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

Annalisa Rubino ¹^*, Neil Roskell ¹, Pat Tennis ², Daniel Mines ³, Scott Weich ⁴, Elizabeth Andrews ⁵

¹ RTI Health Solutions, Manchester Science Park, Manchester M15 6SE
² RTI Health Solutions, Research Triangle Park, NC, USA
³ Global Safety Surveillance and Epidemiology, Wyeth Research, PA, USA
⁴ Warwick Medical School, University of Warwick, Coventry
⁵ Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, USA

^* Correspondence to: arubino{at}rti.org.

Objective To compare the risk of suicide in adults using theantidepressant venlafaxine compared with citalopram, fluoxetine,and dothiepin.

Design Retrospective cohort study.

Setting UK GeneralPractice Research Database.

Participants 219 088 patients, aged18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine,or dothiepin from 1995 to 2005.

Main outcome measures Completedsuicide and attempted suicide.

Results Venlafaxine users hada higher burden of risk factors for suicide, including previoussuicide attempts and proxies for severe depression or depressionthat was difficult to treat. In the analysis for completed suicides,unadjusted and adjusted hazard ratios for venlafaxine comparedwith citalopram were 2.44 (95% confidence interval 1.12 to 5.31)and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetinewere 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxinecompared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53to 3.25). Compared with other study drugs, venlafaxine was alsoassociated with an increased risk of attempted suicide, butadjustment for measured confounders substantially reduced thehazard ratios.

Conclusions Venlafaxine use was consistently associatedwith higher risk of suicide compared with citalopram, fluoxetine,and dothiepin. Venlafaxine users had a higher burden of suiciderisk factors, however, and adjustment for measured confounderssubstantially reduced the excess risks. Since the secondarydata used in this analysis allowed only indirect and partialmeasurements of potential confounders, it is possible that residualconfounding explains much, if not all, of the observed excessrisk.

(Accepted 7 November 2006)

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

StumbleUpon Add to Technorati

Technorati What's this?

Relevant Articles

Bipolarity is important during treatment with antidepressants: Daniel J Smith and James T Walters
BMJ 2007 334: 327. [Extract] [Full Text] [PDF]

On dying and dyeing: Douglas Kamerow
BMJ 2007 334: 0. [Extract] [Full Text]

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

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: David Gunnell, Julia Saperia, and Deborah Ashby
BMJ 2005 330: 385. [Abstract] [Full Text] [PDF]

Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study: Carlos Martinez, Stephan Rietbrock, Lesley Wise, Deborah Ashby, Jonathan Chick, Jane Moseley, Stephen Evans, and David Gunnell
BMJ 2005 330: 389. [Abstract] [Full Text] [PDF]

Antidepressants and suicide: Susan S Jick, Alan D Dean, and Hershel Jick
BMJ 1995 310: 215-218. [Abstract] [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]
Gareri, P., De Fazio, P., Gallelli, L., De Fazio, S., Davoli, A., Seminara, G., Cotroneo, A., De Sarro, G. (2008). Venlafaxine-Propafenone Interaction Resulting in Hallucinations and Psychomotor Agitation. The Annals of Pharmacotherapy 42: 434-438 [Abstract] [Full text]
Smith, D. J, Walters, J. T (2007). Bipolarity is important during treatment with antidepressants. BMJ 334: 327-327 [Full text]
Cipriani, A., Geddes, J. R, Barbui, C. (2007). Venlafaxine for major depression. BMJ 334: 215-216 [Full text]

Rapid Responses:

Read all Rapid Responses

Congratulations !: EUDIER Francis
bmj.com, 13 Dec 2006 [Full text]
Risk of suicide during treatment with antidepressants: the importance of bipolarity.: Daniel J Smith, et al.
bmj.com, 10 Jan 2007 [Full text]
A contemplation but does it change?: Shamuz Oowise
bmj.com, 14 Jan 2007 [Full text]
Suicidal risk with Venlafaxine assessed with the use of GPRD: Some Thoughts!: Nitin Gupta, et al.
bmj.com, 1 Feb 2007 [Full text]
Surviving antidepressant treatment: Rajeev Krishnadas
bmj.com, 5 Feb 2007 [Full text]
is venlafaxine the same as others antidepressants?: nicholas Moore
bmj.com, 5 Feb 2007 [Full text]
Prescribing Venlafaxine: sheeba ninan
bmj.com, 5 Feb 2007 [Full text]
An Index of anti-depressant suicide risk: Michael D Beary
bmj.com, 6 Feb 2007 [Full text]
Impact on patients?: Abhilasha sharma, et al.
bmj.com, 7 Feb 2007 [Full text]
Undetected bipolar depression: James Paul Pandarakalam
bmj.com, 13 Feb 2007 [Full text]
Venlafaxine in depressed suicidal patients: What�s the message?: Nilamadhab Kar, et al.
bmj.com, 7 Mar 2007 [Full text]
Risk of suicide during venlafaxine treatment: further considerations: Elizabeth B. Andrews, et al.
bmj.com, 9 Mar 2007 [Full text]