Antidepressants Do Not Increase Adult-Suicide Risk
August 11, 2006
Antidepressants Do Not Increase Adult-Suicide Risk
Adults with severe depression who take antidepressants appear to be at no higher risk of suicide than adults not taking antidepressant medication, according to a new study. However, the same study confirmed previous reporting linking antidepressants with a higher suicide risk among younger patients.
The study by Mark Olfson, MD, MPH, of the Columbia College of Physicians and Surgeons, and colleagues was published in the August issue of Archives of General Psychiatry and reported by MedPage Today on August 8.
This study differed from those of the US Food and Drug Administration’s (FDA) on which the “black box” warnings were based, in that they examined suicide attempts and successful suicides, instead of suicidal thoughts and behavior, according to Dr Olfson and colleagues.
In October 2004, the FDA issued “black box” warnings concerning all antidepressants. These warning cautioned physicians about antidepressants’ associations with increased risk of suicidal thinking and behavior in both children and adolescents. The FDA warnings were based on a meta-analysis of 24 pediatric trials (>4,400 participants) of various antidepressants.
Study Results
The study showed that, among depressed children and adolescents overall, antidepressants in general raised the rate of suicide-attempts by over 50%. However, this figure is somewhat misleading, because, while some drugs were associated with a much higher risk, others appeared to be associated with no increased risk.
Dr Olfson and colleagues analyzed medical records of about 5,500 people hospitalized for depression one or more times in 1999 or 2000. Within this group, the researchers identified all people who completed suicide (eight children and adolescents, 86 adults) and all people who attempted suicide (263 children and adolescents, 521 adults).
The researchers then matched each of these cases with up to five controls.
Excluded from the study were people who had comorbid conditions associated with increased suicide risk – e.g., bipolar disorder or schizophrenia.
Antidepressants carried a significant association with suicide attempts among children and adolescents (aged 6-18 years). Moreover, the increased risk among younger patients for completed suicide deaths was particularly high. However, the researchers warned that, "because this finding is based on only eight suicide deaths and we cannot preclude the possibility that more severely ill patients tend to be treated with antidepressant drugs, the association should be interpreted with caution."
Suicide risk varied among drug-classes, with tricyclic agents showing a higher risk overall than SSRIs (OR = 1.24 versus 3.09, respectively). Importantly, however, individual drugs within drug classes also had quite variable associations with suicide risk.
Why is risk higher in children?
The apparent higher risk of suicide among children and adolescents versus may be caused by underlying neurobiological differences between children and adults, Dr Olfson speculated in an interview, according to MedPage Today.
He noted that young people in general may be more irritable and impulsive, thereby causing depression in this patients population to be less stable and predictable.
Moreover, the authors wrote, "it is possible that the association between antidepressant drug use and suicide in youths in the present analyses is confined to a relatively narrow band of high-risk or clinically unstable young people after hospitalization for depression and that in the general youth population, antidepressant drugs have a net protective effect on risk of suicide.
"With these caveats in mind, the present findings are consistent with recommendations for careful clinical monitoring during the treatment of depressed children and adolescents with antidepressant medications.”
They concluded, "In practice, physicians face the difficult challenge of balancing safety concerns against evidence that depression is a key risk factor for adult and adolescent suicide and that antidepressant agents are effective for adult and adolescent depression."
The authors noted seven limitations to their study:
- "First, it is possible that antidepressant drugs are selectively prescribed to more severely depressed children and adolescents and that these more severely depressed youths are also at increased risk for suicidal behavior…"
- "Second, no matching was performed on several important but unavailable factors related to suicide risk, such as family history of suicide, imitation and contagion, stressful precipitating events, and access to lethal methods."
- "Third, although pharmacy claims measure psychotropic medication use with reasonable accuracy, pill counts or electronic monitoring might have yielded more accurate information, especially for the short periods measured in this study…"
- "Fourth, the accuracy of the death category "suicide" has been questioned. However, concern tends to focus on underreporting due to religious beliefs, social stigma, and other sources rather than on overreporting, which would pose a greater threat to this case-control design."
- "Fifth, the study is limited to depressed Medicaid beneficiaries who likely differ from depressed privately insured patients in their pharmacologic treatment."
- "Sixth, the study included no adults older than 64 years; therefore, the results cannot be safely generalized to older adults, who differ from middle-aged adults in psychiatric suicide risk factors."
- "Finally, even among nonelderly individuals, the cases are only a small and highly selected sample of total suicide attempts and deaths. It is not known whether similar findings would be observed in a larger and more representative sample of depressed patients."
Sources:
Increased
Antidepressant Suicide Risk Not Found for Adults, MedPage
Today, August 8, 2006.
Antidepressant
Drug Therapy and Suicide in Severely Depressed Children and Adults:
A Case-Control Study. Mark Olfson, MD, MPH, Steven C Marcus,
PhD, and David Shaffer, MD, Archives of General Psychiatry,
volume 63, pages 865-872, 2006.
Pharma Industry News Archive
2007: Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec
2006: Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec
2005: Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec
2004: Jan | Feb | Mar | Apr | May | Jul | Aug | Sep | Oct | Nov | Dec
2003: Jan | Feb | Mar | Apr | May | Jun | Jul | Aug | Sep | Oct | Nov | Dec
2002: Jan | Apr | May | Jun | Aug | Sep | Oct | Nov | Dec
