In this week's BMJ Rubino and colleagues provide new evidence that informs the debate about whether antidepressants increase the risk of suicide.1 The study, a retrospective observational analysis of the General Practice Research Database, found that patients prescribed venlafaxine were more likely to attempt or complete suicide than patients prescribed citalopram, fluoxetine, or dothiepin. Adjustment for possible confounders, however, greatly reduced the excess risk.

Venlafaxine is a serotoninergic and noradrenergic reuptake inhibitor, and it may be more effective than selective serotonin inhibitors for major depression.2 3 However, patients often discontinue treatment because of side effects.4

The database analysed is the world's largest computerised database of anonymised longitudinal medical records from primary care (more than 3.4 million active patients, about 13 million in total since 1987, from around 450 primary care practices throughout the United Kingdom; www.gprd.com). The database has been used extensively for pharmacoepidemiological research, including previous studies examining the possible association between …