Antidepressants and suicide.
OBJECTIVE
To estimate the rate and means of suicide among people taking 10 commonly prescribed antidepressant drugs: dothiepin, amitriptyline, clomipramine, imipramine, flupenthixol, lofepramine, mianserin, fluoxetine, doxepin, and trazodone.


METHODS
Open cohort study with a nested case-control analysis.


METHODS
General practices in the United Kingdom that used VAMP computers to maintain their patient records from January 1988 to February 1993.


METHODS
172,598 people who had at least one prescription for one of the 10 antidepressants during the study period.


METHODS
Suicide confirmed by general practitioner or on death certificate, or both.


RESULTS
143 people committed suicide. The overall rate of suicide was estimated to be 8.5 per 10,000 person years (95% confidence interval 7.2 to 10.0). Rates of suicide were higher in men than women (relative risk 2.8 (95% confidence interval 1.9 to 4.0)), people with a history of feeling suicidal (19.2 (9.5 to 38.7)), and people who had taken several different antidepressants (2.8 (1.8 to 4.3)). People who received high doses of antidepressants and those who had had a prescription in the 30 days before they committed suicide were also at higher risk than those who had received low doses and had had their prescriptions 30 or more days previously (2.3 (1.4 to 3.7) and 2.3 (1.6 to 3.4)) respectively. Rates of suicide were higher in patients who received fluoxetine, but this may be explained by selection biases which were present for those drug users.


CONCLUSIONS
Several factors correlate with the risk of suicide in people taking antidepressants. After controlling for these factors, the risk of suicide was similar among the 10 study antidepressants. Overdose with antidepressants accounted for only 14% of the suicides.
Jick
S S
SS
Boston Collaborative Drug Surveillance Program, Boston University Medical Center, Lexington, MA 02173.
Dean
A D
AD
Jick
H
H
D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000506:poisoning*; D016022:Case-Control Studies; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D004334:Drug Administration Schedule; D062787:Drug Overdose; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
D000928:Antidepressive Agents; D005473:Fluoxetine