The risk of suicide with selective serotonin reuptake inhibitors in the elderly.
OBJECTIVE
The authors explored the relationship between the initiation of therapy with selective serotonin reuptake inhibitor (SSRI) antidepressants and completed suicide in older patients.


METHODS
The authors linked population-based coroner's records with patient-level prescription data, physician billing claims, and hospitalization data for more than 1.2 million Ontario residents 66 years of age and older from 1992 to 2000. For each suicide case, four closely matched comparison subjects were selected using propensity score methods. The authors determined the odds ratio for suicide with SSRIs versus other antidepressant treatment, calculated at discrete monthly intervals from the start of treatment.


RESULTS
Of 1,329 suicide cases, 1,138 (86%) were each fully matched to four comparison subjects using propensity scores. During the first month of therapy, SSRI antidepressants were associated with a nearly fivefold higher risk of completed suicide than other antidepressants (adjusted odds ratio: 4.8, 95% confidence interval=1.9-12.2). The risk was independent of a recent diagnosis of depression or the receipt of psychiatric care, and suicides of a violent nature were distinctly more common during SSRI therapy. Numerous sensitivity analyses revealed consistent results. No disproportionate suicide risk was seen during the second and subsequent months of treatment with SSRI antidepressants, and the absolute risk of suicide with all antidepressants was low.


CONCLUSIONS
Initiation of SSRI therapy is associated with an increased risk of suicide during the first month of therapy compared with other antidepressants. The absolute risk is low, suggesting that an idiosyncratic response to these agents may provoke suicide in a vulnerable subgroup of patients.
Juurlink
David N
DN
Institute for Clinical Evaluative Sciences, G Wing 106, 2075 Bayview Ave., Toronto, Ont., Canada M4N 3M5. dnj@ices.on.ca
Mamdani
Muhammad M
MM
Kopp
Alexander
A
Redelmeier
Donald A
DA
D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D003334:Coroners and Medical Examiners / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data*
D017367:Selective Serotonin Reuptake Inhibitors