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Another Look at Suicide Risk with Antidepressant Use

Case reports and public testimony led to a U.S. FDA advisory in February 2004 that warned of the potential for increased risk for suicidal behavior, particularly in children and adolescents, with most commonly used antidepressants. In this study, researchers assessed suicidal ideation and behavior in 159,810 patients (age range, 10-69) from a British general practice research database. All patients had taken one of four antidepressants: amitriptyline, fluoxetine, paroxetine, or dothiepin (a tricyclic not approved in the U.S.). A total of 555 cases had first-time diagnoses of suicidal ideation or attempted suicide; 2062 controls did not have such diagnoses.

In a multivariate analysis using dothiepin as the reference standard, the odds ratios for suicidal ideation or behavior were 0.83 for users of amitriptyline, 1.16 for fluoxetine, and 1.29 for paroxetine; all differences were nonsignificant. The results were similar in a subgroup analysis of adolescents (age range, 10-19). Risk for nonfatal suicidal behavior was significantly greater early in the course of first-time use of any of the four antidepressants, particularly during days 1 to 9 (OR, 4.07) and days 10 to 29 (OR, 2.88) after prescription, compared with 90 or more days after prescription.

Comment: This study was not designed to answer the fundamental question of whether patients on antidepressants have higher risk for suicide than do untreated depressed patients. However, the results do suggest that there is no difference in risk between fluoxetine, which is approved for use in children and adolescents, and paroxetine, which has been the focus of much of the adverse publicity about increased suicidal ideation (Journal Watch May 11 2004), irrespective of age.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine August 3, 2004

Citation(s):

Jick H et al. Antidepressants and the risk of suicidal behaviors. JAMA 2004 Jul 21; 292:338-43.

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