Antidepressants and suicide risk: retrospective cohort study reports cautious findings

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Research has shown that antidepressant use can lead to a non-significant increase in the risk of suicidal thoughts and behaviour in people aged under 25 (Stone et al, BMJ 2009). This subject rightly received a large amount of media coverage a few years ago and it remains an area where new studies can add to our knowledge and understanding.

A new retrospective cohort study published in the Journal of Clinical Psychopharmacology aims to investigate the risk of suicide in depressed adults who are taking different antidepressants. It’s a large study involving over half a million depressed patients using the US Department of Veterans Affairs Health System.

Patients with bipolar disorder and schizophrenia were excluded from the study.

The researchers gathered data on people who started treatment with 7 different antidepressants:

  • 27.0% of patients started on sertraline
  • 26.1% citalopram
  • 14.0% fluoxetine
  • 13.3% paroxetine
  • 10.9% bupropion
  • 4.4% venlafaxine
  • 4.2% mirtazapine

Data was analysed using a number of different methods:

  • Traditional Cox regression models
  • Inverse probability of treatment weighting (IPTW)
  • Propensity-stratified Cox models (PSCM)
  • Marginal structural models (MSM)
  • Instrumental variable analyses

Here’s what they found:

  • The risk of suicide in adult depression does not differ among people taking most antidepressants
  • In 4 of the 5 analysis methods, sertraline and fluoxetine were associated with significantly lower risks of suicide death than paroxetine (sertraline: HRs 0.57 to 0.64, p<0.05; fluoxetine: HRs 0.52 to 0.60, p<0.05)
  • The divergence in findings across the various methods of analysis mean that we should interpret these results with caution

If you need help

If you need help and support now and you live in the UK or the Republic of Ireland, please call the Samaritans on 116 123.

If you live elsewhere, we recommend finding a local Crisis Centre on the IASP website.

We also highly recommend that you visit the Connecting with People: Staying Safe resource.

Links

Valenstein M, Kim HM, Ganoczy D, Eisenberg D, Pfeiffer PN, Downing K, Hoggatt K, Ilgen M, Austin KL, Zivin K, Blow FC, McCarthy JF. Antidepressant agents and suicide death among US Department of Veterans Affairs patients in depression treatment. J Clin Psychopharmacol. 2012 Jun;32(3):346-53. [Abstract]

Stone M, Laughren T, Jones ML, et al. Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009; 339: b2880

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