Suicide risk and the SSRIs

Article · August 2004with3 Reads
DOI: 10.1001/jama.292.3.379 · Source: PubMed
    • Positive results are usually considered more interesting (and publishable) than negative results, and the results of many trials are under disclosure. Therefore, published trials together provide an incomplete picture of overall research results678910111213141516171819202122. Clinical trial registration was thus established to improve the transparency of clinical trials, reducing selective outcome reporting.
    [Show abstract] [Hide abstract] ABSTRACT: Result publication is the key step to improve the transparency of clinical trials. To investigate the result publication rate of Chinese trials registered in World Health Organization (WHO) primary registries. We searched 11 WHO primary registries for Chinese trials records. The progress of each trial was analyzed. We searched for the full texts of result publications cited in the registration records. For completed trials without citations, we searched PubMed, Embase, Chinese Biomedical Literature Database (Chinese), China Knowledge Resource Integrated Database, and Chinese Science and Technology Periodicals Database for result publications. The search was conducted on July 14, 2009. We also called the investigators of completed trials to ask about results publication. We identified 1294 Chinese trials records (428 in ChiCTR,743 in clinicaltrials.gov,55 in ISRCTN, 21 in ACTRN). A total of 443 trials had been completed. The publication rate of the Chinese trials in WHO primary registries is 35.2% (156/443).The publication rate of Chinese trials in clinicaltrials.gov, ChiCTR, ISRCTN, and ACRTN was 36.5% (53/145), 36.3% (89/245), 26.0% (9/44), and 55.6% (5/9), respectively. The publication rate of trials sponsored by industry (23.8%) was lower than that of sponsored by central and local government (31.7%), hospital (35.1%), and universities (40.7%). The publication rate for randomized trials was higher than that of cohort study and case-control study (33.2% versus 16.7%, 22.2%). The publication rate for interventional studies and observational studies was similar (33.4% versus 33.3%). The publication rate of the registered Chinese trials was low, with no significant difference between ChiCTR and clinicaltrials.gov. An effective mechanism is needed to promote publication of results for registered trials in China.
    Full-text · Article · Sep 2010
    • Clinicians have long recognized, and research confirms, that suicidal behaviour may be elevated during the first month of TCA or NGA treatment (although this was not replicated in the paediatric trial data [3]) [5,94]. This may simply mean that antidepressants are being prescribed for the right indication [95]. The FDA strongly suggest that in some children and adolescents the starting of SSRIs can induce agitation or akathisia, 'suicidality', irritability and aggressive behaviour.
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of the present paper was to identify, from the voluminous literature on efficacy and safety in new-generation antidepressants (NGAs) with depressed children and adolescents, practical clinical strategies for acute phase treatment. To this end a pragmatic survey of studies and reviews was undertaken. Meta-analyses of randomized controlled trials of NGAs in depressed children and adolescents have noted a comparative lack of efficacy, and a weak but statistically significant increased risk of self-harm and suicidal thoughts. But NGA prescription rates and youth suicide rates are generally inversely related, and ensuing 'black box' warnings about NGAs, by deterring NGA prescribing, have possibly contributed to rising youth suicide rates. In moderate-severe depression, benefits for fluoxetine and possibly other NGAs demonstrably outweigh risks. NGAs are not present in adolescents who die by suicide. Concern about NGA risks must be balanced against risks of non-treatment. While mild depression entails regular review, psychoeducation, self-care strategies and psychological interventions, NGAs should be administered concurrently with psychological treatments if depression is moderate- to severe, or if mild depression persists. Patients should be warned about off-label status of NGAs in depression, serious side-effects such as 'activation', suicidality, emotional blunting and manic switches, the need for adherence and avoiding abrupt discontinuation. They should be monitored early and regularly. Better evidence is required regarding psychological treatments, clinical course, and clinical practice trends. In moderate-severe depression the risk of suicide if NGAs are not used may outweigh any risk of self-harm associated with them.
    Full-text · Article · Jul 2008
    • An increase in suicidal ideation with antidepressants is still a matter of debate1234567891011 . The advent of SSRI antidepressants appears to have been accompanied with significant decrease in suicide rates in most countries with traditionally high baseline suicide rates [12,13].
    [Show abstract] [Hide abstract] ABSTRACT: The possible increase of suicidal ideation with some antidepressants is still a matter of debate. We are reporting two cases of suicidal attempt that occurred concomitantly with the use of Duloxetine. To our knowledge there is no prior publication about a possible Duloxetine related increase in the risk of suicidality.
    Full-text · Article · Feb 2008
    • Although there is agreement that treatment with antidepressants relieves depressive Archives of Suicide Research, 11:163–175, 2007 Copyright # International Academy for Suicide Research ISSN: 1381-1118 print/1543-6136 online DOI: 10.1080/13811110701249889 disorder (Bauer, Whybrow, Angst et al., 2002b) and reduces the risk of recurrence (Bauer, Whybrow, Angst et al., 2002a; Frank, Kupfer, Perel et al., 1990; Kupfer, Frank, Perel et al., 1992), it is unclear whether continued treatment reduces the risk of suicide. Cases have been reported suggesting that SSRIs and newer non-SSRI antidepressants may induce suicidal behavior (Healy, 2003; The Medicines and Health Regulatory , 2003; Wessely and Kerwin, 2004); however, increasing use of newer antidepressants has coincided with a decreased suicide rate in many developed countries, e.g., in the US (Gibbons, Hur, Bhaumik et al., 2005; Maris, 2002), Canada (Statistics Canada, 2004), England (McClure, 2000), Norway (Statistics Norway, 2004), Austria, Australia, Czechoslovakia, Estonia, Finland, France, Germany, Hungary, Sweden, and Denmark (Rihmer, 2004) but not in Iceland (Helgason, Tomasson, & Zoega, 2004). We used register linkage of pharmacoepidemiological data and data on psychiatric diagnoses and suicide in an observationally designed study.
    [Show abstract] [Hide abstract] ABSTRACT: Antidepressant use in Denmark, as in many developed countries, has substantially increased during recent years, coinciding with a decreasing suicide rate. In a nationwide observational cohort study with linkage of registers of all prescribed antidepressants and recorded suicides in Denmark from 1995 to 2000, we investigated the relation between continued treatment with antidepressants and suicide in a population of all patients discharged from hospital psychiatry with a diagnosis of depressive disorder. Patients discharged from hospital psychiatry with a diagnosis of depressive disorder had a highly increased rate of suicide. Those who continued treatment with antidepressants had a decreased rate of suicide compared with those who purchased antidepressants once (rate ratio: 0.31, 95% confidence interval: 0.26-0.36). Further, the rate of suicide decreased consistently with the number of prescriptions. On individualized data from a cohort of patients with a known history of depressive disorder, continued antidepressant treatment was associated with reduced risk of suicide.
    Full-text · Article · Feb 2007
    • If more knowledge leads to more balanced attitudes and more active involvement in ensuring clients' needs are met, it would have implications for educational programs. As a backdrop to these questions, there are major scientific debates taking place in the medical journals and in Congress about whether pharmaceutical companies, which control and fund most drug studies, have deliberately distorted scientific reports about their effectiveness (Angell, 2004; Meier, 2004 ) and whether certain antidepressant drugs promote suicidality among youths (Goode, 2003; Wessely & Kerwin, 2004). Perhaps more than ever, social workers need to stay informed, vigilant, and critically minded.
    [Show abstract] [Hide abstract] ABSTRACT: There is considerable controversy among mental health professionals and the public about the proper role of psychotropic medications in the treatment of youths. Within social work, too, there have been sharp differences of opinion. There have been few studies, however, about the views of practicing clinical social workers on the use of psychiatric drugs in the treatment of youths. This study, a cross-sectional survey of a national sample of social workers, examines their views about medications and the role they may play in the treatment of youths.The findings suggest that social workers hold complex views that recognize both the potential benefits and harms ofpsychotropic medications, but overall they seem to support their use in a judicious manner.
    Article · Aug 2006
    • Treatment with antidepressants relieves depression (Bauer et al., 2002b), reduces the risk of recurrence (Frank et al., 1990; Kupfer et al., 1992; Bauer et al., 2002a) and there are some suggestions that treatment with antidepressants reduces the risk of suicide (Leon et al., 1999; Angst et al., 2002). On the one hand, cases have been reported suggesting that selective serotonin reuptake inhibitors (SSRIs) (Committee on Safety of Medicines' Expert Working Group, 2004 ) and other new-generation non-SSRI antidepressants may induce suicidal behaviour (Committee on Safety of Medicines' Expert Working Group, 2004; Jick et al., 2004; Wessely and Kerwin, 2004). On the other hand, a recent study based on computerized health plan records did not indicate a significant increase in the risk of suicide or suicide attempts after starting treatment with newer antidepressant drugs (Simon et al., 2006).
    [Show abstract] [Hide abstract] ABSTRACT: As in many developed countries, the use of antidepressants in Denmark has been substantially increasing during recent years, coinciding with a decreasing suicide rate. We aimed to investigate the relationship between treatment with antidepressants and suicide on individualized data from a nationwide study comprising an observational cohort study with linkage of registers of all prescribed antidepressants and recorded suicides in Denmark during the period 1995-99. A total of 438 625 patients who purchased at least one prescription of antidepressants and 1073 862 individuals from the general population were included in the study. Patients who continued treatment with selective serotonin reuptake inhibitors (SSRIs) (i.e. who purchased SSRIs twice or more) had a decreased rate of suicide compared with patients who purchased SSRIs once only [rate ratio (RR)=0.63; 95% confidence interval (CI)=0.56-0.71]. Furthermore, the rate of suicide decreased consistently with the number of prescriptions. Similarly, among patients treated with newer antidepressants other than SSRIs, the rate of suicide was decreased compared with the rate for patients who purchased other newer antidepressants once only (RR=0.70; 95% CI=0.52-0.94). Continued antidepressant treatment with SSRIs or other newer antidepressants is found to be associated with a reduced risk of suicide.
    Full-text · Article · Aug 2006
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