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SUICIDE AND ANTIDEPRESSANTS: INCREASED RISK WITH TRICYCLICS.

Suicide attempts by drug overdose are a major concern in patients taking pharmacologic agents for depression. This analysis of data from three national sources indicates that patients taking tricyclic agents are at greater risk for successful suicide than patients taking other antidepressants.

The authors combined data from U.S. poison control centers and the Drug Abuse Warning Network (DAWN) to estimate the number of attempted and completed suicides among users of various antidepressants. Total drug exposure was estimated from the National Prescription Audit. Desipramine was associated with the highest rate of suicide attempts; overdoses were attempted 27 percent more often than with trazodone in the poison control data and 51 percent more often than with fluoxetine in the DAWN data. Suicide attempt rates also seemed to be slightly elevated with other tricyclics. More striking was the risk of death after overdose: in the poison control data, desipramine was associated with a 17-fold higher risk of death than trazodone, and other tricyclic agents had relative risks ranging from 6 to 9.

The greater risk of fatal overdose with the tricyclic agents appears to be due not to a higher rate of attempted suicide, but to a higher rate of successful attempts. These data should be considered when prescribing antidepressants for potentially suicidal patients.

— THL

Published in Journal Watch General Medicine January 5, 1993

Citation(s):

Kapur S et al. Antidepressant medications and the relative risk of suicide attempt and suicide. JAMA 1992 Dec 23 268 3441-3445.

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