Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study.
OBJECTIVE
To compare the risk of non-fatal self harm and suicide in patients taking selective serotonin reuptake inhibitors (SSRIs) with that of patients taking tricyclic antidepressants, as well as between different SSRIs and different tricyclic antidepressants.


METHODS
Nested case-control study.


METHODS
Primary care in the United Kingdom.


METHODS
146,095 individuals with a first prescription of an antidepressant for depression.


METHODS
Suicide and non-fatal self harm.


RESULTS
1968 cases of non-fatal self harm and 69 suicides occurred. The overall adjusted odds ratio of non-fatal self harm was 0.99 (95% confidence interval 0.86 to 1.14) and that of suicide 0.57 (0.26 to 1.25) in people prescribed SSRIs compared with those prescribed tricyclic antidepressants. We found little evidence that associations differed over time since starting or stopping treatment. We found some evidence that risks of non-fatal self harm in people prescribed SSRIs compared with those prescribed tricyclic antidepressants differed by age group (interaction P = 0.02). The adjusted odds ratio of non-fatal self harm for people prescribed SSRIs compared with users of tricylic antidepressants for those aged 18 or younger was 1.59 (1.01 to 2.50), but no association was apparent in other age groups. No suicides occurred in those aged 18 or younger currently or recently prescribed tricyclic antidepressants or SSRIs.


CONCLUSIONS
We found no evidence that the risk of suicide or non-fatal self harm in adults prescribed SSRIs was greater than in those prescribed tricyclic antidepressants. We found some weak evidence of an increased risk of non-fatal self harm for current SSRI use among those aged 18 or younger. However, preferential prescribing of SSRIs to patients at higher risk of suicidal behaviour cannot be ruled out.
Martinez
Carlos
C
General Practice Research Database Division, Medicines and Healthcare products Regulatory Agency, London SW8 5NQ.
Rietbrock
Stephan
S
Wise
Lesley
L
Ashby
Deborah
D
Chick
Jonathan
J
Moseley
Jane
J
Evans
Stephen
S
Gunnell
David
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000139:chemically induced* / Q000453:epidemiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013405:Suicide / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
BMJ. 2002 Dec 7;325(7376):1332-3
12468481
JAMA. 2004 Jul 21;292(3):338-43
15265848
BMJ. 1995 Jan 28;310(6974):215-8
7677826
BMJ. 1994 May 7;308(6938):1227-33
8080520
Drug Saf. 2004;27(12):871-81
15366975
BMJ. 2004 Jul 3;329(7456):34-8
15231620
IARC Sci Publ. 1987;(82):1-406
3329634
Psychother Psychosom. 2003 Mar-Apr;72(2):71-9
12601224
Psychol Med. 2003 Aug;33(6):987-95
12946083
Br J Psychiatry. 2004 Jul;185:70-5
15231558
Lancet. 2004 May 22;363(9422):1728-31
15158638
Lancet. 2004 Apr 24;363(9418):1341-5
15110490
Br J Psychiatry. 1997 Dec;171:556-60
9519096
Int J Risk Saf Med. 1997;10(2):75-126
23511318