Among adults beginning antidepressant therapy, the risk of suicide or suicide attempts does not appear to vary by individual type or class of medication, according to a report in the May issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Despite the widespread use of antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs), there is inconsistent evidence that growth in antidepressant use has reduced the prevalence of suicidal ideation or suicide attempts during the past decade," the authors write as background information in the article. In October 2004, the U.S. Food and Drug Administration issued an advisory regarding a potentially increased risk in suicidal thoughts and behaviors among children and adolescents taking antidepressants. Subsequent analyses found no increased risk of suicidality in adult antidepressant users; however, these analyses and advisories have not provided patients, clinicians or policy makers with adequate guidance on treatment decisions.
"In the current study, we sought to address whether the risk of suicide is equal across antidepressant classes and agents after adjustment for selection factors -- or whether there are particular regimens with safety advantages that should be prescribed preferentially in adult populations," write Sebastian Schneeweiss, M.D., Sc.D., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues. The researchers analyzed health care utilization data from 287,543 adults in British Columbia, Canada, who had initiated antidepressant therapy between 1997 and 2005.
During the first year of antidepressant use, a total of 846 adults in this population either attempted (751) or completed (104) suicide. Most of these events occurred in the first six months after beginning treatment.
There was no clinically meaningful difference in risk among individuals taking different classes of medications, including SSRIs, serotonin-norepinephrine reuptake inhibitors, tricyclic agents and other newer and atypical agents. In addition, there were no significant differences among individual medications, including fluoxetine, citalopram, fluvoxamine, paroxetine and sertraline.
"Our finding of equal event rates across antidepressant agents supports the U.S. Food and Drug Administration's decision to treat all antidepressants alike in their advisory," they conclude. "Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent."
- Sebastian Schneeweiss; Amanda R. Patrick; Daniel H. Solomon; Jyotsna Mehta; Colin Dormuth; Matthew Miller; Jennifer C. Lee; Philip S. Wang. Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults: A Propensity Score-Adjusted Analysis of 9 Years' Data. Archives of General Psychiatry, 2010; 67 (5): 497-506 [link]
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