Suicide risk drops with antidepressants

Jan 2 2006

According to a new study the risk of suicide is not increased when adults start using antidepressants, and does in fact drop almost as soon as medication is begun.

The study which was long-term and population-based, poses a challenge to FDA advice in 2004 which warned that there was a higher risk of suicidal behavior among children and teenagers and ordered strong label warnings on such drugs.

The study led by Group Health Cooperative researchers, shows that the risk of serious suicide attempts or death by suicide generally decreases in the weeks after patients start taking antidepressant medication.

It also found that the risk of suicidal behavior after starting 10 newer antidepressant medications is less than the risk posed by older medications.

Greg Simon, MD, MPH, a Group Health psychiatrist and the lead researcher says the findings show that suicide attempts and death by suicide are rare following the initiation of antidepressants, and the period right after people start taking antidepressant medication is not a period of increased risk.

It is in fact lower than before.

The team found that after reviewing more than 65,000 patient records from 1992 to 2003, there were fewer suicide attempts or deaths after patients began medication.

That decline was more significant among patients taking the newer drugs now used to treat depression, including selective serotonin reuptake inhibitors, or SSRIs, compared to those taking older medicines.

Group Health researchers found that the number of suicide attempts fell by 60 percent in adults during the month after antidepressant treatment began, and declined further in the following five months.

It appears that in the six months after medication, there were 76 attempts severe enough to require a hospital visit compared with 73 attempts in the three months prior.

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.

The rate was highest in the month before treatment and declined by about 60 percent after treatment began.

In view of recent public concern over a possible link between suicide and antidepressants, Simon says he worries that people may believe that suicidal behavior is common after taking antidepressant medications, and that misperception could lead to fewer people with depression being treated with medications proven to be effective in battling depression.

Simon agrees with the FDA that doctors should carefully monitor people taking antidepressants in order to ensure they are getting the right medication in the right amounts.

The National Institute of Mental Health funded the study and they say the results may help uncover why only certain patients benefit from the drugs.

Susan Cruzan an FDA spokeswoman says the findings would not affect current warnings on labels.

Another study, which is also published this week has found that anti-depression medications only help 50% of those who take them.

According to researchers at as many as 14 medical institutions, around 33% of 3,000 patients taking the drug Celexa, fully recovered from their symptoms, which can include a change in sleep patterns, eating habits or concentration.

Another 10 to 15 percent found some relief, while the rest, about 53 percent, had no improvement.

Both studies are published in the January issue of the American Journal of Psychiatry.