Suicide risk and the SSRIs
Available from: Per K Andersen
- "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). "
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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.
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ABSTRACT: Across Europe, around one in four adults experience a mental health problem in any 1year. It is estimated that 2–6% of children
and adolescents suffer from depression and suicide is now the third leading cause of death in 10–19year olds. Despite traditional
Freudian teachings that children rarely suffer from clinically diagnosed depression, treatment figures for juvenile depression
have soared in recent years. For adults, the current treatment trend, as advocated by the National Institute for Health and
Clinical Excellence (NICE), is the use of Selective Serotonin Reuptake Inhibitors (SSRIs), such as Prozac. For children, efficacy
of such treatment remains difficult to judge as all SSRI use in paediatric care remains ‘off-label’ or unlicensed. Notwithstanding
this, in 2006 the European Medicines Agency (EMEA) advocated the use of Prozac within the EU for children from the age of
eight, a position that reinforced the stance adopted by NICE in 2005. These recommendations have been made despite growing
concern that many SSRIs have some serious side effects. In new legislation for paediatric medicines, that came into effect
on 26th January 2007, the European Union (EU) has attempted to address several unresolved issues relating to children’s needs
for medicines in Europe. This paper considers the position of off-label drug-therapy for juvenile depression, and assesses
the effectiveness of available legal mechanisms that can protect juveniles from harm when involved in clinical drug trials,
most notably the Clinical Trial Regulations 2004. It further reviews the new EU legislation and evaluates its likely impact.
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