Suicide and self‐harm following prescription of SSRIs and other antidepressants: confounding by indication

Rebecca C. Didham · Doug W. McConnell · Hayden J. Blair · David Martin Reith

59 citations0/0 files storedBritish Journal of Clinical Pharmacology

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Suicide and Self-Harm Studies Treatment of Major Depression Opioid Use Disorder Treatment

Abstract

AIM: To identify the incidence and risk of suicide and self harm, among patients prescribed antidepressant drugs. METHODS: A retrospective cohort study, with nested case control, of patients identified from a nonrandom sample of general practices in New Zealand from 1996 to 2001. A total of 57 361 patients who received a prescription for a single antidepressant were identified from the RNZCGP Research Unit Database. Suicides within 120 days of a prescription were identified from the New Zealand National Mortality Database and self-harm events within 120 days of a prescription were identified from the New Zealand Hospital discharge database. RESULTS: 26 suicides and 330 episodes of self-harm were identified within 120 days of an antidepressant prescription. On univariate analysis the association, expressed as OR (95% CI), between selective serotonin reuptake inhibitors (SSRIs) and self harm and suicide were 2.26 (1.27-4.76) and 1.92 (0.77-4.83), respectively. When corrected for the confounding effects of age, gender and depression/suicidal ideation there was an association between SSRIs and self harm, OR 1.66 (95% CI 1.23-2.23), but not for suicide, 1.28 (0.38-4.35). Paroxetine was a significant risk factor for suicide on univariate analysis, 4.23 (1.19-14.95), but not when corrected for age, gender and depression/suicidal ideation, 2.76 (0.30-24.87). CONCLUSIONS: Age, gender and pre-existing depression/suicidal ideation are important confounders in observational studies of the association between antidepressants and suicide or self harm.

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References

2004Antidepressants and the Risk of Suicidal Behaviors 2005Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials 2003Suicide Rates in Clinical Trials of SSRIs, Other Antidepressants, and Placebo: Analysis of FDA Reports 1991Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression.1995Antidepressants and suicide 2005Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study 2003Trends in mortality from suicide, 1965–99 2003Occurrence and Course of Suicidality During Short-term Treatment of Late-Life Depression

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2008Practice Guideline for the Treatment of Patients With Obsessive-Compulsive Disorder 2010Antidepressants and Suicide Risk: A Comprehensive Overview

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