In March 2004, the US Food and Drug Administration (FDA) issued a public health advisory warning of worsening
and increased risk of suicide in people being treated with 10 newer antidepressants (bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, escitalopram, and venalfaxine). The advisory recommended close observation of patients being treated with these antidepressants, especially when treatment is initiated or the dose is increased. The evidence behind this advisory is limited. One study linked several newer antidepressants with “possibly suicide-related events” in adolescents, but no evidence exists indicating increased risk in adults.
A new study in the January 2006 issue of the
American Journal of Psychiatry
investigated more than 80,000 episodes of antidepressant treatment and found no increase risk of suicide or serious suicide attempt after starting treatment with newer antidepressant drugs.
About the Study
This study used data from the Group Health Cooperative, a prepaid health plan serving about 500,000 members in Washington and Idaho. The researchers identified 82,285 episodes of antidepressant treatment among 65,103 health plan members over the course of 10.5 years. The researchers assessed the risk of suicide in the months before and after initiation of antidepressant treatment, and compared risks associated with 10 newer antidepressants versus older antidepressants.
The risk of serious suicide attempts (e.g., suicide attempt leading to hospitalization) was highest in the month before starting antidepressant treatment, fell by more than half in the first month after starting medication, and declined progressively after that. The higher rate of suicide attempts during the month before starting treatment was primarily attributable to the increased risk in the seven days before the prescription. Among people taking newer antidepressants, the risk was highest in the month before starting treatment, and not significantly different in month one compared to months 2-6 after starting treatment. Among those treated with older drugs, the risk was highest in the first month after starting treatment.
This study was limited because the database only recorded antidepressant prescriptions, not whether the patients took their medications. It is possible that suicide deaths and/or attempts were associated with lapses or discontinuation of medication. Also, since this is an observational study (rather than a randomized trial), factors other than the antidepressant prescription cannot be ruled out as explanations for the results.
How Does This Affect You?
These results do not indicate a significant increase in suicide risk associated with starting treatment with newer antidepressant drugs. On the contrary, this study supports a decline in suicide risk after initiation of antidepressant medications. Most likely, people begin taking antidepressants when their depression is the most severe, and the full benefits of the medication take a few weeks to set in.
This study suggests that newer antidepressant medications are safe. However, any patient initiating drug therapy for their depression should still be closely monitored for signs of worsening depression, including suicidal thoughts or behaviors. If you or someone you know is taking antidepressants and the depression worsens consult a doctor immediately. And never stop taking antidepressants without consulting with your doctor.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a