Microsoft word - suicide-low lit.doc

Studies Show
Suicide risk during antidepressant therapy. 2006 American Journal of Psychiatry; 163:1:41-7
Treatment for Depression and Suicide
What is the problem and what is known about it?
Thoughts of suicide and actual suicide are common in patients who have major
depression. In 2004, the Federal Drug Administration (FDA) warned of high rates of
suicide in patients being treated with newer anti-depression drugs. The FDA asked that
doctors closely watch all patients treated with these drugs for possible suicide. They also
asked that drug makers have a warning about this risk on the drug labels.
The warning was based on a review of many studies on this topic. The authors found that
past studies did not take into account key information in figuring out the role of anti-
depression drugs in suicide. They point out that past studies did not look at the rate of
suicide attempts before the start of drug treatment. Also, they found that there were no
comparisons between suicide attempts and suicide deaths at the start of drug treatment.
Why was this study done?
The authors state that most suicides happen before, not after, the patient starts drug
treatment for depression. They wanted to answer these questions:
• What is the risk of serious suicide attempt (leads to a hospital stay) and death by
suicide at the start of drug treatment for depression? • Is there a higher risk of serious suicide attempt or death by suicide during the month • Are the newer drugs stated in the FDA warning linked with higher risk of serious suicide attempt or death by suicide than are older drug treatments?
Who was studied?
• 65,103 members of a large health plan in the Pacific Northwest of the U.S. o They must have had a recent diagnosis of depression. o They must have been given drug treatment for depression by a doctor.
How was the study done?
Researchers studied the medical records of members of the health plan. These included
pharmacy records, registration records, hospital discharge records, and state and national
death certificates.
What did they find?
Results show that at the start of drug treatment for depression the rates of serious suicide
attempt are about 90 attempts in every 100,000 people. Rates of death from suicide are
about 40 in every 100,000 people. This shows that there is a risk. However, their results
do not show a higher risk after starting drug treatment. Instead, the risk of suicide
attempt was highest in the month before the first treatment. The risk fell by more than
half in the month after starting the drugs, and lessened through the next months. Also, it
Studies Show
Suicide risk during antidepressant therapy. 2006 American Journal of Psychiatry; 163:1:41-7
was found that the risk of suicide was not higher among those patients treated with newer
drugs, compared to those treated with older drugs.
What are the problems with the study?
Based on the study design, it is hard to prove or disprove a connection between drug
treatment for depression and suicide risk. To do so there would need to be more studies
on the effects of a single drug vs. a placebo (sugar pill) in more than 300,000 people to
find a meaningful difference in risk. Also, the information used was taken from one
health care system whose policies and culture may differ from that of the average U.S.
population. Finally, some have wondered whether suicide attempts during drug treatment
for depression may be because patients are not taking the drugs as told to. Whether
patients’ followed their doctor’s orders for drug treatment was not looked at in this study.
What does the study mean?
The study does not show a definite higher risk of suicide or serious suicide attempt after
starting treatment with newer drugs for depression. This result may change the feeling
that some doctors have toward using newer drug treatments for depression. Better
follow-up care by doctors after a new drug is given will make following treatment better
for patients and will improve the likelihood of patients staying with the treatment.
*Drugs studied: bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine,
nefazodone, paroxetine, sertraline, escitalopram, venlafaxine.
National Institute of Mental Health:, 866-615-6464
National Alliance on Mental Illness:, 800-950-6264
National Mental Health Association:, 800-969-6642


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