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Long-term, population-based study challenges FDA advisory which warned of
suicidal behavior at start of therapy.
The risk of serious suicide
attempts or death by suicide generally decreases in the
weeks after patients start taking
according to a new study led by Group Health Cooperative
researchers and published in the January issue of The
American Journal of Psychiatry. The study also found that
the risk of suicidal behavior after starting 10 newer
is less than the risk posed by older medications.
These findings challenge a 2004 advisory
by the U. S. Food and Drug Administration (FDA), which warned that
suicidal behavior may emerge after treatment with the newer
antidepressant drugs has begun.
"Our findings show that, fortunately,
suicide attempts and death by suicide are rare following the
antidepressants," says Greg Simon, MD, MPH, a Group Health
psychiatrist and the lead researcher on the study. "The period right
after people start taking
antidepressant medication is not a period of increased risk. In
fact, risk after starting medication is lower than before."
This study is the first published analysis
to compare the risk of suicide attempts before treatment to the
risks following treatment. It is based on computerized medical and
pharmacy records for more than 65, 000 patients who filled
antidepressants from 1992 to 2003. Deaths by suicide were
determined from death certificates and suicide attempts were
identified from hospital discharge data.
Group Health researchers found that the
number of suicide attempts fell by 60 percent in adults during the
antidepressant treatment began, and declined further in the
following five months. Among the 65, 103 patients taking
antidepressants, there were 31 completed suicides in the six
months following the
antidepressant prescription. That rate was not higher in the one
month after the prescription than in subsequent months. The study
also found that newer
antidepressants were associated with a faster decline in rates
of suicidal behavior than older drugs.
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Adolescents in the study had more suicide
attempts than adults. The researchers found that the rate for the
first six months of
antidepressant treatment was 314 attempts per 100, 000 in teens
and 78 attempts per 100, 000 in adults. As with adults, the rate was
highest in the month before treatment and declined by about 60
percent after treatment began.
Given recent public concern over a
possible link between suicide and
antidepressants, Simon says he fears people may mistakenly
believe that suicidal behavior is common after taking
antidepressant medications. That misperception could lead to
fewer people with depression
being treated with medications proven to be effective in battling
depression, he adds.
"There may be subgroups of people who
become more agitated or suicidal after taking these drugs, and those
people should seek help from a doctor or therapist right away if
that happens," says Simon. "But our study showed that on average,
the risk of suicide actually goes down after people start taking the
Simon agrees with the FDA's
recommendations that doctors carefully monitor people taking
antidepressants. "Keeping a close watch on patients after they
begin taking these drugs is a good idea--although not because these
medicines are especially risky or dangerous," he says. "Patients
need to be monitored to ensure they're getting the right medication
in the amount that can help them feel better."