Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults
Identifieur interne : 001978 ( Main/Exploration ); précédent : 001977; suivant : 001979Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults
Auteurs : Sebastian Schneeweiss ; Amanda R. Patrick ; Daniel H. Solomon ; Jyotsna Mehta ; Colin Dormuth ; Matthew Miller ; Jennifer C. Lee ; Philip S. WangSource :
- Archives of general psychiatry [ 0003-990X ] ; 2010.
Abstract
A US Food and Drug Administration advisory has warned that antidepressants may be associated with an increased risk of suicidal thoughts and behaviors in adolescents. This prompted a meta-analysis of trials in adults that found no overall increase in risk, but individual agents could not be studied.
To assess the risk of suicide and suicide attempts associated with individual antidepressant agents.
Cohort study of incident users of antidepressant agents.
Population-based health care utilization data of all residents of British Columbia, Canada, aged 18 years and older between January 1, 1997, and December 31, 2005.
British Columbia residents who had antidepressant therapy initiated and had a recorded diagnosis of depression.
Initiation of various antidepressant medications.
Combined suicide death or hospitalization due to self-harm.
In a population of 287 543 adults aged 18 years and older with antidepressant therapy initiated, we observed outcome rates ranging from 4.41/1000 person-years to 9.09/1000 person-years. Most events occurred in the first 6 months after treatment initiation. After extensive propensity score adjustment, we found no clinically meaningful variation in the risk of suicide and suicide attempt between antidepressant agents compared with fluoxetine hydrochloride initiation: citalopram hydrobromide, hazard ratio=1.00 (95% confidence interval, 0.63–1.57); fluvoxamine maleate, hazard ratio=0.98 (95% confidence interval, 0.63–1.51); paroxetine hydrochloride, hazard ratio=1.02 (95% confidence interval, 0.77–1.35); and sertraline hydrochloride, hazard ratio = 0.75 (95% confidence interval, 0.53–1.05). Compared with selective serotonin reuptake inhibitors as a drug class, other classes including serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents had a similar risk. Restriction to patients with no antidepressant use in the past 3 years further reduced apparent differences between groups.
Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration’s decision to treat all antidepressants alike in their advisory. Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent.
Url:
DOI: 10.1001/archgenpsychiatry.2010.39
PubMed: 20439831
PubMed Central: 2884225
Affiliations:
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Solomon</name></author><author><name sortKey="Mehta, Jyotsna" sort="Mehta, Jyotsna" uniqKey="Mehta J" first="Jyotsna" last="Mehta">Jyotsna Mehta</name></author><author><name sortKey="Dormuth, Colin" sort="Dormuth, Colin" uniqKey="Dormuth C" first="Colin" last="Dormuth">Colin Dormuth</name></author><author><name sortKey="Miller, Matthew" sort="Miller, Matthew" uniqKey="Miller M" first="Matthew" last="Miller">Matthew Miller</name></author><author><name sortKey="Lee, Jennifer C" sort="Lee, Jennifer C" uniqKey="Lee J" first="Jennifer C." last="Lee">Jennifer C. Lee</name></author><author><name sortKey="Wang, Philip S" sort="Wang, Philip S" uniqKey="Wang P" first="Philip S." last="Wang">Philip S. Wang</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20439831</idno><idno type="pmc">2884225</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2884225</idno><idno type="RBID">PMC:2884225</idno><idno type="doi">10.1001/archgenpsychiatry.2010.39</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">000397</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000397</idno><idno type="wicri:Area/Pmc/Curation">000397</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000397</idno><idno type="wicri:Area/Pmc/Checkpoint">000A07</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000A07</idno><idno type="wicri:Area/Ncbi/Merge">000C58</idno><idno type="wicri:Area/Ncbi/Curation">000C58</idno><idno type="wicri:Area/Ncbi/Checkpoint">000C58</idno><idno type="wicri:doubleKey">0003-990X:2010:Schneeweiss S:variation:in:the</idno><idno type="wicri:Area/Main/Merge">001A82</idno><idno type="wicri:Area/Main/Curation">001978</idno><idno type="wicri:Area/Main/Exploration">001978</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults</title><author><name sortKey="Schneeweiss, Sebastian" sort="Schneeweiss, Sebastian" uniqKey="Schneeweiss S" first="Sebastian" last="Schneeweiss">Sebastian Schneeweiss</name></author><author><name sortKey="Patrick, Amanda R" sort="Patrick, Amanda R" uniqKey="Patrick A" first="Amanda R." last="Patrick">Amanda R. Patrick</name></author><author><name sortKey="Solomon, Daniel H" sort="Solomon, Daniel H" uniqKey="Solomon D" first="Daniel H." last="Solomon">Daniel H. Solomon</name></author><author><name sortKey="Mehta, Jyotsna" sort="Mehta, Jyotsna" uniqKey="Mehta J" first="Jyotsna" last="Mehta">Jyotsna Mehta</name></author><author><name sortKey="Dormuth, Colin" sort="Dormuth, Colin" uniqKey="Dormuth C" first="Colin" last="Dormuth">Colin Dormuth</name></author><author><name sortKey="Miller, Matthew" sort="Miller, Matthew" uniqKey="Miller M" first="Matthew" last="Miller">Matthew Miller</name></author><author><name sortKey="Lee, Jennifer C" sort="Lee, Jennifer C" uniqKey="Lee J" first="Jennifer C." last="Lee">Jennifer C. Lee</name></author><author><name sortKey="Wang, Philip S" sort="Wang, Philip S" uniqKey="Wang P" first="Philip S." last="Wang">Philip S. Wang</name></author></analytic><series><title level="j">Archives of general psychiatry</title><idno type="ISSN">0003-990X</idno><idno type="eISSN">1538-3636</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Context</title><p id="P1">A US Food and Drug Administration advisory has warned that antidepressants may be associated with an increased risk of suicidal thoughts and behaviors in adolescents. This prompted a meta-analysis of trials in adults that found no overall increase in risk, but individual agents could not be studied.</p></sec><sec id="S2"><title>Objective</title><p id="P2">To assess the risk of suicide and suicide attempts associated with individual antidepressant agents.</p></sec><sec id="S3"><title>Design</title><p id="P3">Cohort study of incident users of antidepressant agents.</p></sec><sec id="S4"><title>Setting</title><p id="P4">Population-based health care utilization data of all residents of British Columbia, Canada, aged 18 years and older between January 1, 1997, and December 31, 2005.</p></sec><sec id="S5"><title>Patients</title><p id="P5">British Columbia residents who had antidepressant therapy initiated and had a recorded diagnosis of depression.</p></sec><sec id="S6"><title>Intervention</title><p id="P6">Initiation of various antidepressant medications.</p></sec><sec id="S7"><title>Main Outcome Measures</title><p id="P7">Combined suicide death or hospitalization due to self-harm.</p></sec><sec id="S8"><title>Results</title><p id="P8">In a population of 287 543 adults aged 18 years and older with antidepressant therapy initiated, we observed outcome rates ranging from 4.41/1000 person-years to 9.09/1000 person-years. Most events occurred in the first 6 months after treatment initiation. After extensive propensity score adjustment, we found no clinically meaningful variation in the risk of suicide and suicide attempt between antidepressant agents compared with fluoxetine hydrochloride initiation: citalopram hydrobromide, hazard ratio=1.00 (95% confidence interval, 0.63–1.57); fluvoxamine maleate, hazard ratio=0.98 (95% confidence interval, 0.63–1.51); paroxetine hydrochloride, hazard ratio=1.02 (95% confidence interval, 0.77–1.35); and sertraline hydrochloride, hazard ratio = 0.75 (95% confidence interval, 0.53–1.05). Compared with selective serotonin reuptake inhibitors as a drug class, other classes including serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents had a similar risk. Restriction to patients with no antidepressant use in the past 3 years further reduced apparent differences between groups.</p></sec><sec id="S9"><title>Conclusions</title><p id="P9">Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration’s decision to treat all antidepressants alike in their advisory. Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent.</p></sec></div></front></TEI><affiliations><list></list><tree><noCountry><name sortKey="Dormuth, Colin" sort="Dormuth, Colin" uniqKey="Dormuth C" first="Colin" last="Dormuth">Colin Dormuth</name><name sortKey="Lee, Jennifer C" sort="Lee, Jennifer C" uniqKey="Lee J" first="Jennifer C." last="Lee">Jennifer C. Lee</name><name sortKey="Mehta, Jyotsna" sort="Mehta, Jyotsna" uniqKey="Mehta J" first="Jyotsna" last="Mehta">Jyotsna Mehta</name><name sortKey="Miller, Matthew" sort="Miller, Matthew" uniqKey="Miller M" first="Matthew" last="Miller">Matthew Miller</name><name sortKey="Patrick, Amanda R" sort="Patrick, Amanda R" uniqKey="Patrick A" first="Amanda R." last="Patrick">Amanda R. Patrick</name><name sortKey="Schneeweiss, Sebastian" sort="Schneeweiss, Sebastian" uniqKey="Schneeweiss S" first="Sebastian" last="Schneeweiss">Sebastian Schneeweiss</name><name sortKey="Solomon, Daniel H" sort="Solomon, Daniel H" uniqKey="Solomon D" first="Daniel H." last="Solomon">Daniel H. Solomon</name><name sortKey="Wang, Philip S" sort="Wang, Philip S" uniqKey="Wang P" first="Philip S." last="Wang">Philip S. Wang</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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