Antidepressants and suicide

Abstract Objective : To estimate the rate and means of suicide among people taking 10 commonly prescribed antidepressant drugs: dothiepin, amitriptyline, clomipramine, imipramine, flupenthixol, lofepramine, mianserin, fluoxetine, doxepin, and trazodone. Design : Open cohort study with a nested casecontrol analysis. Setting : General practices in the United Kingdom that used VAMP computers to maintain their patient records from January 1988 to February 1993. Subjects : 172598 people who had at least one prescription for one of the 10 antidepresssants during the study period. Main outcome measure : Suicide confirmed by general practitioner or on death certificate, or both. Results : 143 people committed suicide. The overall rate of suicide was estimated to be 8.5 per 10000 person years (95% confidence interval 7.2 to 10.0). Rates of suicide were higher in men than women (relative risk 2.8 (95% confidence interval 1.9 to 4.0)), people with a history of feeling suicidal (19.2 (9.5 to 38.7)), and people who had taken several different antidepressants (2.8 (1.8 to 4.3)). People who received high doses of antidepressants and those who had had a prescription in the 30 days before they committed suicide were also at higher risk than those who had received low doses and had had their prescriptions 30 or more days previously (2.3 (1.4 to 3.7) and 2.3 (1.6 to 3.4)) respectively. Rates of suicide were higher in patients who received fluoxetine, but this may be explained by selection biases which were present for those drug users. Conclusion : Several factors correlate with the risk of suicide in people taking antidepressants. After controlling for these factors, the risk of suicide was similar among the 10 study antidepressants. Overdose with antidepressants accounted for only 14% of the suicides. Key messages Key messages As in previous studies, more men than women committed suicide People with a history of suicidal behaviour were at a greatly increased risk of committing suicide People who had received their last antidepressant prescription in the previous 30 days were more likely to commit suicide than those who had received their last antidepressant 30 or more days previously The risk of suicide was not determined by the antidepressant prescribed