The Pharmaceutical Journal
Vol 276 No 7384 p65
21 January 2006

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Antidepressants and suicide risk debate continues

Further evidence to support the use of newer antidepressants in adults has emerged from a study published this month. Data reported in the American Journal of Psychiatry suggest that patients are not at greater risk of suicide or serious attempted suicide after they start to take newer antidepressant drugs (2006; 163:1).
Investigators identified 65,103 patients with 82,285 episodes of antidepressant treatment (with both newer and older agents) by using computerised health plan records. They found the risk of death by suicide to be approximately one in 3,000, and the risk of admission to hospital due to suicide attempt to be approximately one in 1,000.

The researchers found a pattern more consistent with a decline in suicide risk over the months of treatment rather than a medication-induced increase. Additionally, they found that the risk was highest in the month before the initial prescription, most likely because suicide attempts then prompted antidepressant treatment.

Month-by-month comparison of newer and older agents indicates that subjects taking the older antidepressants were at as high a risk of suicide attempt in the first month of treatment as in the preceding month (possibly due to the delayed onset of action of the drugs). The same trend was not seen for the newer agents, which, the researchers say, “certainly argue[s] against any increase in risk specific to newer antidepressants”.

The study adds further fuel to the debate on the safety of newer antidepressants, particularly selective serotonin reuptake inhibitors, but does not provide data about suicidal thoughts or self-harm in patients, or help to answer concerns surrounding the safety of antidepressants in adolescents or children.

Paediatrics A newly published article in the Canadian Medical Association Journal reviews the current evidence of efficacy and safety for antidepressants used in the treatment of depression in children and adolescents, and discusses the methodological limitations of the available studies (2006;174:193).