title: Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study.
abstract: 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.
authors.affiliation: General Practice Research Database Division, Medicines and Healthcare products Regulatory Agency, London SW8 5NQ.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martinez
authors.forename: Stephan
authors.initials: S
authors.lastname: Rietbrock
authors.forename: Lesley
authors.initials: L
authors.lastname: Wise
authors.forename: Deborah
authors.initials: D
authors.lastname: Ashby
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chick
authors.forename: Jane
authors.initials: J
authors.lastname: Moseley
authors.forename: Stephen
authors.initials: S
authors.lastname: Evans
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
mesh_terms: 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
chemical_list: D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
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