Suicidal behavior is higher in the first month after starting antidepressants

A new study in the current issue of The Journal of the American Medical Association reports that the risk of suicidal behavior is higher in the first month after starting antidepressants.

The authors of the article note that public attention is focused on the relationship between use the of antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs), and suicidal inclinations and behaviors.

SSRIs or Selective Serotonin Reuptake Inhibitors are antidepressant drugs that act by blocking the reuptake of serotonin so that more serotonin is available to act on receptors in the brain.

Hershel Jick, M.D., and colleagues with the Boston Collaborative Drug Surveillance Program, Boston University, estimated the relative risks of non-fatal suicidal behavior in patients in the United Kingdom starting treatment with the SSRIs fluoxetine and paroxetine and another antidepressant, amitriptyline—compared with patients starting treatment with a fourth drug, dothiepin, that is not available in the U.S. Amtriptyline and dothiepin belong to a class of drugs known as tricyclic antidepressants. Participants could have used only one of the antidepressants, and had to have received at least one prescription for the drug within 90 days before their index date (the date of suicidal behavior or ideation for cases, and the same date for matched controls).

“The risk of suicidal behavior after starting antidepressant treatment is similar among users of amitriptyline, fluoxetine, and paroxetine compared with the risk among users of dothiepin,” the authors write. “The risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first one to nine days,” they report. “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 behavior in patients newly diagnosed and treated than in those who have been treated for a longer time.”

“Based on limited information, we also conclude that there is no substantial difference in effect of the four drugs on people aged ten to 19 years,” the authors write.

“Given the careful control of potential confounding variables, including age, sex, calendar time, and duration of treatment prior to suicidal behavior, this study provides evidence that the risk of suicidal behavior is not substantially different among patients starting treatment with amitriptyline, fluoxetine, or paroxetine than among patients starting treatment with dothiepin,” they conclude. “The available information on young people aged ten through 19 years is limited, however, and some important difference in effect cannot be ruled out based on this study.”

The rate at which antidepressant drugs are prescribed for the nation’s children and adolescents is now a major concern with recent research from Washington State University suggesting three fold increases between the early 1990s and 2001.