Risk of Suicide, Suicide Attempt Similar Across Types of Antidepressant Medication
New research shows that among adults beginning antidepressant therapy, the risk of suicide or suicide attempts does not appear to vary by individual type or class of medication.
Boston, MA, June 13, 2010 --(PR.com)-- According to new research from Brigham and Women's Hospital, in adults beginning antidepressant therapy, the risk of suicide or suicide attempts does not appear to vary by individual type or class of medication. This research is published in the May issue of Archives of General Psychiatry.
"Despite the widespread use of antidepressant medications, particularly selective serotonin re-uptake 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."
This research was supported by the National Institute of Mental Health.
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit http://www.brighamandwomens.org/.
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"Despite the widespread use of antidepressant medications, particularly selective serotonin re-uptake 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."
This research was supported by the National Institute of Mental Health.
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit http://www.brighamandwomens.org/.
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Suzanne Benz
(617) 534-1604
http://www.brighamandwomens.org/
75 Francis Street
Boston, MA 02115 USA
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