The debate about antidepressant use and suicide in young people rages on. A new meta-analysis of placebo-controlled paroxetine trials has been published in the Journal of Clinical Psychiatry by a research team at GlaxoSmithKline (the company who make the drug also known as Aropax, Paxil and Seroxat) in Pennsylvania.
This kind of drug company conducted meta-analysis always raises alarm bells, but it’s interesting to read on when the study findings are not wholly positive, as they are not in this case.
The meta-analysis uses data from the GlaxoSmithKline paroxetine clinical trial database, including all double-blind, randomized, placebo-controlled, parallel-group studies of paroxetine therapy in adults (14,911 patients in total from 61 trials).
The study found:
- no significant differences between paroxetine and placebo for overall suicidality (suicidal behavior or ideation: n/n = 83/8,958 [0.93%] vs n/n = 65/5,953 [1.09%], respectively; OR = 0.9 [95% CI, 0.7-1.3]; P = .649)
- no difference for suicidal behavior specifically (n/n = 50/8,958 [0.56%] vs n/n = 40/5,953 [0.67%], respectively; OR = 1.2 [95% CI, 0.8-1.9]; P = .483).
- a greater incidence of suicidal behavior occurred in paroxetine-treated patients with depression than in placebo-treated patients (n/n = 11/3,455 [0.32%] vs n/n = 1/1,978 [0.05%], respectively; OR = 6.7 [95% CI, 1.1-149.4]; P = .058).
- a higher incidence of suicidal behavior occurred in paroxetine-treated versus placebo-treated adults aged 18 to 24 years (n/n = 17/776 [2.19%] vs n/n = 5/542 [0.92%], respectively; OR = 2.4 [95% CI, 0.9-7.3]).
- no increase in suicidality was observed in older people.
The authors concluded:
Across all disorders, overall suicidality incidence was similar between paroxetine and placebo. However, a higher frequency of suicidal behavior occurred with paroxetine in major depressive disorder, which was largely explained by the higher incidence in young adults.
These data support the efficacy of paroxetine therapy; however, they also highlight the need for careful monitoring of suicidality during antidepressant therapy, particularly in younger adults.
Carpenter DJ, Fong R, Kraus JE, Davies JT, Moore C, Thase ME. Meta-analysis of efficacy and treatment-emergent suicidality in adults by psychiatric indication and age subgroup following initiation of paroxetine therapy: a complete set of randomized placebo-controlled trials. J Clin Psychiatry. 2011 Feb 22. [Epub ahead of print] [PubMed abstract].
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