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Antidepressants and Suicide Attempts in Adults
Gibbons R, Brown C, Hur K, Marcus S, et al.
Posted: September 2007  
American Journal of Psychiatry  2007;164:1044-1049

An analysis of a large VA database provides further evidence that SSRIs do not cause suicide attempts in adults with new-episode depression. According to FDA data, risk is increased in patients aged 18-25 years but results of this analysis do not support that finding.

Methods:   A cohort of nearly 227,000 patients (including about 1250 patients aged 18-24 years) who suffered from depressive or unipolar mood disorders in 2003 or 2004 and had at least 6 months of follow-up were included in the analysis of serious suicide attempts. About 26% of patients were not treated with an antidepressant, 36% received SSRI monotherapy, 12% received monotherapy with new-generation non-SSRIs, 4% received a tricyclic, and 23% were treated with multiple agents. All treatment groups had a similar age and gender composition and a similar duration of follow-up.

Results:   After the start of treatment, the incidence of suicide attempts in patients receiving SSRI monotherapy was one-third the rate in patients who had never received an antidepressant. Suicide attempts were also less frequent in patients who had received tricyclics or other antidepressants. The incidence of suicide attempts was significantly lower after the start of antidepressant treatment. Rates following the start of treatment were about 38% lower than pretreatment rates in patients who received SSRIs, 40% lower in those taking non-SSRIs, and 50% lower in those taking tricyclics. When the analysis was repeated by age group, the results were similar, though the reduction was not statistically significant in patients under age 24, possibly because of the smaller sample size and small number of events.

Discussion:   The agreement of the comparisons between treated and untreated patients and between before-and-after rates in the same patients lends further support to the conclusion that SSRIs do not put patients at greater risk for suicide.