Risk of suicidal behavior similar among users of different antidepressant drugs


CHICAGO The risk of suicidal behavior is increased in the first month after starting antidepressants, and is similar among users of four antidepressant drugs, according to a study in the July 21 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, considerable public attention recently has focused on the relation between use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), and suicidal ideation (having thoughts of suicide or of taking action to end one's own life) and suicidal behaviors. SSRIs are antidepressant drugs that work by making available more serotonin, a chemical in the brain that is thought to play a key role in depression and anxiety. The use of antidepressant drugs among teenagers has been of particular concern.

Hershel Jick, M.D., and colleagues with the Boston Collaborative Drug Surveillance Program, Boston University, estimated the relative risks of non-fatal suicidal behavior in patients in the United Kingdom starting treatment with the SSRIs fluoxetine and paroxetine and another antidepressant, amitriptyline--compared with patients starting treatment with a fourth drug, dothiepin, that is not available in the U.S. Amtriptyline and dothiepin belong to a class of drugs known as tricyclic antidepressants. Participants could have used only one of the antidepressants, and had to have received at least one prescription for the drug within 90 days before their index date (the date of suicidal behavior or ideation for cases, and the same date for matched controls).

"The risk of suicidal behavior after starting antidepressant treatment is similar among users of amitriptyline, fluoxetine, and paroxetine compared with the risk among users of dothiepin," the authors write. "The risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first one to nine days," they report. "We think the most likely explanation for this finding is that antidepressant treatment may not be immediately effective, so there is a higher risk of suicidal behavior in patients newly diagnosed and treated than in those who have been treated for a longer time."

"Based on limited information, we also conclude that there is no substantial difference in effect of the four drugs on people aged ten to 19 years," the authors write.

"Given the careful control of potential confounding variables, including age, sex, calendar time, and duration of treatment prior to suicidal behavior, this study provides evidence that the risk of suicidal behavior is not substantially different among patients starting treatment with amitriptyline, fluoxetine, or paroxetine than among patients starting treatment with dothiepin," they conclude. "The available information on young people aged ten through 19 years is limited, however, and some important difference in effect cannot be ruled out based on this study." (JAMA. 2004; 292:338-343. Available post-embargo at JAMA.com)

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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