Does suicide risk differ with different antidepressants?

January 01, 0001

Does suicide risk differ with different antidepressants?

These US authors assessed the risk of suicide and suicide attempts associated with individual antidepressant agents. They analyzed a Canadian cohort of incident users of antidepressant agents aged 18 years and older between January 1, 1997, and December 31, 2005. It was composed of British Columbia residents who had antidepressant therapy initiated and had a recorded diagnosis of depression.

They found: "In a population of 287,543 adults aged 18 years and older with antidepressant therapy initiated, we observed outcome rates ranging from 4.41/1000 person-years to 9.09/1000 person-years. Most events occurred in the first 6 months after treatment initiation. After extensive propensity score adjustment, we found no clinically meaningful variation in the risk of suicide and suicide attempt between antidepressant agents compared with fluoxetine hydrochloride initiation: citalopram hydrobromide, hazard ratio = 1.00; fluvoxamine maleate, hazard ratio = 0.98; paroxetine hydrochloride, hazard ratio = 1.02; and sertraline hydrochloride, hazard ratio = 0.75. Compared with selective serotonin reuptake inhibitors as a drug class, other classes including serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents had a similar risk. Restriction to patients with no antidepressant use in the past 3 years further reduced apparent differences between groups."

The authors concluded: "Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration's decision to treat all antidepressants alike in their advisory. Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent."

These data are from a large enough population to be reassuring.

For the full abstract, click here.

Arch Gen Psychiatry 67(5):497-506, May 2010
© 2010 to the American Medical Association
Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults-A Propensity Score-Adjusted Analysis of 9 Years' Data. Sebastian Schneeweiss, Amanda R. Patrick, Daniel H. Solomon, et al. Correspondence to: Dr. Schneeweiss: [email protected]

Category: P.Psychological. Keywords: suicide, depression, antidepressants, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, tricyclics, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 18 May 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.