Risk of suicidal behaviour is similar for SSRIs and tricyclics
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《英国医生杂志》
Risk of suicidal behaviour after starting to take antidepressants was similar for four antidepressant drugs, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, a study in JAMA has found (2004;292:338-43). Suicidal behaviour is more likely in the first month after starting antidepressants, especially during the first nine days.
The researchers—Dr Hershel Jick and colleagues with the Boston Collaborative Drug Surveillance Program, Boston University, Massachusetts—compared the risk of non-fatal suicidal behaviour in patients in the United Kingdom who began treatment with one of three antidepressants (the SSRIs fluoxetine and paroxetine and the tricyclic amitriptyline) with the risk in patients who started taking the older tricyclic dosulepin (formerly known as dothiepin).
Cases taking a single antidepressant were taken from the base population of 159 810 users of at least one of the four antidepressants who had been prescribed the drug within 90 days of the date of suicidal behaviour or ideation. Controls, also taken from the base population, were matched for taking the same antidepressant within 90 days before the case showed suicidal behaviour, age, and sex, but the controls had shown no suicidal behaviour.
Variation in suicidal behaviour with the different antidepressants was not significant. The relative risks of newly diagnosed non-fatal suicidal behaviour in 555 cases and 2062 controls were 0.83 (95% confidence interval 0.61 to 1.13) for amitriptyline, 1.16 (0.90 to 1.50) for fluoxetine, and 1.29 (0.97 to 1.70) for paroxetine compared with patients taking dosulepin.
After starting to take an antidepressant, patients were much more likely to develop suicidal behaviour in the first nine days than after 90 days (odds ratio 4.07; 95% confidence interval 2.89 to 5.74).
"The risk of suicidal behaviour is increased in the first month after starting antidepressants, especially during the first one to nine days," the authors wrote, "We think the most likely explanation for this finding is that antidepressant treatment may not be immediately effective, so there is a higher risk of suicidal behaviour in patients newly diagnosed and treated than in those who have been treated for a longer time."
In an editorial in the same journal (pp 379-81), Simon Wessely of the Institute of Psychiatry, London, wrote, "The results confirm that antidepressant prescription is indeed associated with suicidal behaviour, and strongly so. This simply means that antidepressants are being prescribed for the right indication, and that they do not immediately eliminate suicide risk. That we knew."
The authors of the study noted, however, that for teenagers aged 10 to 19 years the data is limited, and some important difference in effect cannot be ruled out.
"Whatever decision clinicians reach, careful monitoring of adolescents (for activation, agitation, and suicidal ideation) prescribed any antidepressant remains essential," Dr Wessely concluded.
Competing interests: SG worked as a senior medical adviser to the Food and Drug Administration抯 commissioner from March 2003 until May 2004.(New York Scott Gottlieb)
The researchers—Dr Hershel Jick and colleagues with the Boston Collaborative Drug Surveillance Program, Boston University, Massachusetts—compared the risk of non-fatal suicidal behaviour in patients in the United Kingdom who began treatment with one of three antidepressants (the SSRIs fluoxetine and paroxetine and the tricyclic amitriptyline) with the risk in patients who started taking the older tricyclic dosulepin (formerly known as dothiepin).
Cases taking a single antidepressant were taken from the base population of 159 810 users of at least one of the four antidepressants who had been prescribed the drug within 90 days of the date of suicidal behaviour or ideation. Controls, also taken from the base population, were matched for taking the same antidepressant within 90 days before the case showed suicidal behaviour, age, and sex, but the controls had shown no suicidal behaviour.
Variation in suicidal behaviour with the different antidepressants was not significant. The relative risks of newly diagnosed non-fatal suicidal behaviour in 555 cases and 2062 controls were 0.83 (95% confidence interval 0.61 to 1.13) for amitriptyline, 1.16 (0.90 to 1.50) for fluoxetine, and 1.29 (0.97 to 1.70) for paroxetine compared with patients taking dosulepin.
After starting to take an antidepressant, patients were much more likely to develop suicidal behaviour in the first nine days than after 90 days (odds ratio 4.07; 95% confidence interval 2.89 to 5.74).
"The risk of suicidal behaviour is increased in the first month after starting antidepressants, especially during the first one to nine days," the authors wrote, "We think the most likely explanation for this finding is that antidepressant treatment may not be immediately effective, so there is a higher risk of suicidal behaviour in patients newly diagnosed and treated than in those who have been treated for a longer time."
In an editorial in the same journal (pp 379-81), Simon Wessely of the Institute of Psychiatry, London, wrote, "The results confirm that antidepressant prescription is indeed associated with suicidal behaviour, and strongly so. This simply means that antidepressants are being prescribed for the right indication, and that they do not immediately eliminate suicide risk. That we knew."
The authors of the study noted, however, that for teenagers aged 10 to 19 years the data is limited, and some important difference in effect cannot be ruled out.
"Whatever decision clinicians reach, careful monitoring of adolescents (for activation, agitation, and suicidal ideation) prescribed any antidepressant remains essential," Dr Wessely concluded.
Competing interests: SG worked as a senior medical adviser to the Food and Drug Administration抯 commissioner from March 2003 until May 2004.(New York Scott Gottlieb)