title: Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study.
abstract: OBJECTIVE
  To compare the risk of suicide in adults using the antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  UK General Practice Research Database.
  
  
  METHODS
  219,088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005.
  
  
  METHODS
  Completed suicide and attempted suicide.
  
  
  RESULTS
  Venlafaxine users had a higher burden of risk factors for suicide, including previous suicide attempts and proxies for severe depression or depression that was difficult to treat. In the analysis for completed suicides, unadjusted and adjusted hazard ratios for venlafaxine compared with citalopram were 2.44 (95% confidence interval 1.12 to 5.31) and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetine were 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxine compared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53 to 3.25). Compared with other study drugs, venlafaxine was also associated with an increased risk of attempted suicide, but adjustment for measured confounders substantially reduced the hazard ratios.
  
  
  CONCLUSIONS
  Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk.
authors.affiliation: RTI Health Solutions, Manchester Science Park, Manchester M15 6SE. arubino@rti.org
authors.forename: Annalisa
authors.initials: A
authors.lastname: Rubino
authors.forename: Neil
authors.initials: N
authors.lastname: Roskell
authors.forename: Pat
authors.initials: P
authors.lastname: Tennis
authors.forename: Daniel
authors.initials: D
authors.lastname: Mines
authors.forename: Scott
authors.initials: S
authors.lastname: Weich
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Andrews
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D015283:Citalopram / Q000009:adverse effects; D015331:Cohort Studies; D003511:Cyclohexanols / Q000009:adverse effects; D004308:Dothiepin / Q000009:adverse effects; D005473:Fluoxetine / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D000069470:Venlafaxine Hydrochloride
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D003511:Cyclohexanols; D005473:Fluoxetine; D015283:Citalopram; D000069470:Venlafaxine Hydrochloride; D004308:Dothiepin