Do Antidepressants Trigger Suicide?

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Over the past 30 years, there have been many isolated reports that certain anti depressants may induce suicidal thoughts and self-destructive behaviors. Almost all manufacturers who make anti depressants even add warnings to the packages about worsening of depression and triggering of suicides. The question that has always been difficult to answer is whether antidepressants actually induce suicidal thoughts or these thoughts are just a part of undertreated depression.

One recent large study from Europe suggests that antidepressants infrequently trigger suicidal thoughts or destructive behaviors. This large study undertaken by Dr. Susanne Stubner of Ludwig-Maximilian University in Munich, Germany. The researchers analyzed medical reports from a drug surveillance program covering more than 300,000 patients treated in psychiatric hospitals in several European countries including Germany, Austria and Switzerland between 1993 and 2008. The drug surveillance data included 142,090 adult patients, who were regularly taking at least one antidepressant, most commonly mirtazapine or venlafaxine.

The researchers only discovered 33 patients who had thoughts of wanting to commit suicide that doctors thought were "possibly" or "probably" related to the antidepressant medication. Eighteen of these patients attempted suicide and three more completed suicides. More than 50 percent of these patients were taking selective serotonin reuptake inhibitors (SSRIs), and 45 percent were also taking some type of benzodiazepine. In the entire study group of patients on antidepressants, 37 percent were taking SSRIs and 32 percent were on benzodiazepines in addition to antidepressants.

Stubner and her colleagues did acknowledge that their study may have missed on some individuals with drug-related suicidal thoughts or acts since the study only relied on drug surveillance reports and not direct interviews with patients. Based on this, the authors concluded that anti depressants rarely trigger suicidality.

This is by no means a clear-cut study and there are other researchers who believe that the study simply assumed that suicidal thoughts and behaviors are a part of the patient’s illness or probably missed out on taking details that are more thorough from the patients.

Moreover, many experts caution against reading too much into this study. Says Dr Marc Stone, from the US FDA, "This study can only identify the tip of the iceberg, Because many patients were hospitalized because they were suicidal or likely to become suicidal, subsequent suicidal thinking or behavior is much more likely to be attributed to the patient's psychiatric condition rather than the drug even if the drug is, in fact, the cause."

Moreover, Stone stated that perhaps many patients in the study had likely been on an antidepressant for a long time before they were hospitalized. Most cases of drug-related suicidal thoughts and behavior happen soon after a patient starts taking an antidepressant. Therefore, it is unlikely that these individuals would be revealed in the follow up study.

Final note: The medical community generally tends to pay more attention to large studies involving many patients believing that bigger is better and more reliable. Unfortunately, in such large studies, doctors are rarely asked about their own personal experiences with such patients. In fact, many doctors may unwittingly not report patients with suicidal tendencies in their own patients taking antidepressants because they tend to believe what the large study claims.

Finally, the majority of European drug surveillance programs are funded by pharmaceutical companies and there is always a question about reliability of such studies. In fact, many researchers often tend to minimize harmful effects of drugs, especially when the study is paid by the drug company.

Said Dr Healy, “Whether antidepressant drugs trigger any suicidal behavior is not in question. This is a problem that is caused by the drugs and the study confirms that the link exists. The only argument is about how frequently it's happening.”
http://www.medscape.com/viewarticle/728027

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