Type of antidepressant doesn't seem to affect suicide, suicide attempts in adults

Risk for suicide and suicide attempts does not appear to differ among different types of antidepressants, according to a new study.

In 2004, the FDA issued an advisory warning of possible increased suicide risk in children and adolescents taking antidepressants. While a subsequent meta-analysis of trials in adults found no such increase in risk, individual drugs could not be studied. The authors performed a cohort study using population-based health care utilization data from British Columbia, Canada, to examine rates of death by suicide or self-harm-related hospitalization in patients taking antidepressants. The goal of the study was to examine the risk associated with individual antidepressant agents. The study results appear in the May Archives of General Psychiatry.

Data were available for 287,543 adults 18 years of age or older with a diagnosis of depression. Over half (56.2%) were women, while 2.8% reported substance abuse, 1.6% reported anxiety and sleep disorders, 1.6% reported psychotic disorder, and 5.6% reported other mental disorders. Rates of suicide or hospitalization due to self-harm ranged from 4.41 events per 1,000 patient-years to 9.09 events per 1,000 patient-years, most of which occurred within six months of treatment initiation.

The authors found no difference in risk for suicide or suicide attempts for specific drugs when compared with fluoxetine hydrochloride. Hazard ratios were as follows: citalopram hydrobromide, 1.00 (95% CI, 0.63 to 1.57); fluvoxamine maleate, 0.98 (95% CI, 0.63 to 1.51); paroxetine hydrochloride, 1.02 (95% CI, 0.77 to 1.35); and sertraline hydrochloride, 0.75 (95% CI, 0.53 to 1.05).

The authors also looked at drug classes and found that serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents all conferred similar risk compared with selective serotonin reuptake inhibitors.

The study's definitions of completed and attempted suicide were imperfect, the authors acknowledged, noting that coroners may misclassify suicide as “other injuries” in up to 10% of cases. The authors also did not have data on patients who were treated in emergency departments for injuries due to suicide attempts and then released. However, the authors concluded that risk for suicide and suicide attempts among adults is similar across all classes of antidepressants as well as for individual drugs. “Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent,” they wrote.