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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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></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></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><pmc article-type="research-article" xml:lang="EN"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0372435</journal-id><journal-id journal-id-type="pubmed-jr-id">744</journal-id><journal-id journal-id-type="nlm-ta">Arch Gen Psychiatry</journal-id><journal-title>Archives of general psychiatry</journal-title><issn pub-type="ppub">0003-990X</issn><issn pub-type="epub">1538-3636</issn></journal-meta><article-meta><article-id pub-id-type="pmid">20439831</article-id><article-id pub-id-type="pmc">2884225</article-id><article-id pub-id-type="doi">10.1001/archgenpsychiatry.2010.39</article-id><article-id pub-id-type="manuscript">NIHMS200656</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults</article-title><subtitle>A Propensity Score–Adjusted Analysis of 9 Years’ Data</subtitle></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Schneeweiss</surname><given-names>Sebastian</given-names></name><degrees>MD, ScD</degrees></contrib><contrib contrib-type="author"><name><surname>Patrick</surname><given-names>Amanda R.</given-names></name><degrees>MS</degrees></contrib><contrib contrib-type="author"><name><surname>Solomon</surname><given-names>Daniel H.</given-names></name><degrees>MD, MPH</degrees></contrib><contrib contrib-type="author"><name><surname>Mehta</surname><given-names>Jyotsna</given-names></name><degrees>MS</degrees></contrib><contrib contrib-type="author"><name><surname>Dormuth</surname><given-names>Colin</given-names></name><degrees>MA, MS, ScD</degrees></contrib><contrib contrib-type="author"><name><surname>Miller</surname><given-names>Matthew</given-names></name><degrees>MD, ScD</degrees></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Jennifer C.</given-names></name><degrees>BS</degrees></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Philip S.</given-names></name><degrees>MD, DrPH</degrees></contrib><aff id="A1"><bold>Author Affiliations:</bold> Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School (Drs Schneeweiss, Solomon, and Wang and Mss Patrick, Mehta, and Lee) and Harvard Injury Control Research Center, Department of Health Policy and Management, Harvard School of Public Health (Dr Miller), Boston, Massachusetts; Therapeutics Initiative, Department of Anesthesia, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada (Dr Dormuth); and National Institute of Mental Health, Bethesda, Maryland (Dr Miller).</aff></contrib-group><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Sebastian Schneeweiss, MD, ScD, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 1620 Tremont St, Ste 3030, Boston, MA 02120 (<email>schneeweiss@post.harvard.edu</email>)</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>20</day><month>5</month><year>2010</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2010</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>5</month><year>2011</year></pub-date><volume>67</volume><issue>5</issue><fpage>497</fpage><lpage>506</lpage><permissions><copyright-statement>©2010 American Medical Association. All rights reserved.</copyright-statement><copyright-year>2010</copyright-year></permissions><abstract><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></abstract><contract-num rid="MH1">U01 MH078708-04
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