Use of calcium channel blockers and risk of suicide: ecological findings confirmed in population based cohort study

Abstract Objective: To investigate possible associations between use of cardiovascular drugs and suicide. Design: Cross sectional ecological study based on rates of use of eight cardiovascular drug groups by outpatients. A population based cohort study including users of drugs to control hypertension. Subjects: The ecological study included 152 of Sweden9s 284 municipalities. The cohort study included all inhabitants of one Swedish municipality who during 1988 or 1989 had purchased cardiovascular agents from pharmacies within the municipality. Six hundred and seventeen subjects (18.2%) were classified as users of calcium channel blockers and 2780 (81.8%) as non-users. Main outcome measures: Partial correlations (least squares method) between rates of use of cardiovascular drugs and age standardised mortality from suicide in Swedish municipalities. Hazard ratios for risk of suicide with adjustments for difference in age and sex in users of calcium channel blockers compared with users of other hypertensive drugs. Results: Among the Swedish municipalities the use of each cardiovascular drug group except angiotensin converting enzyme inhibitors correlated significantly and positively with suicide rates. After adjustment for the use of other cardiovascular drug groups, as a substitute for the prevalence of cardiovascular morbidity, only the correlation with calcium channel blockers remained significant (r=0.29, P<0.001). In the cohort study, five users and four non-users of calcium channel blockers committed suicide during the follow up until the end of 1994. The absolute risk associated with use of calcium channel blockers was 1.1 suicides per 1000 person years. The relative risk, adjusted for differences in age and sex, among users versus non-users was 5.4 (95% confidence interval 1.4 to 20.5). Conclusions: Use of calcium channel blockers may increase the risk of suicide. Key messages Clinical trials have a limited ability to detect infrequent adverse effects, so postmarketing reports on adverse effects and observational epidemiological studies are necessary The present investigations, including one cross sectional ecological study and one population based cohort study, suggest an increased risk of suicide in users of calcium channel blockers The results are in accordance with a depressive effect of calcium channel blockers suggested by case reports and a recent epidemiological study Channel blockers should be considered a possible cause of depression and suicide