title: Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort.
abstract: BACKGROUND
  It is unknown if antidepressant treatment is associated with either increased or decreased risk of suicide.
  
  
  OBJECTIVE
  To estimate the risk of suicide, attempted suicide, and overall mortality during antidepressant treatments in a real-life setting with high statistical power.
  
  
  METHODS
  A cohort study in which all subjects without psychosis, hospitalized because of a suicide attempt from January 1, 1997, to December 31, 2003, in Finland, were followed up through a nationwide computerized database.
  
  
  METHODS
  A total of 15 390 patients with a mean follow-up of 3.4 years.
  
  
  METHODS
  The propensity score-adjusted relative risks (RRs) during monotherapy with the most frequently used antidepressants compared with no antidepressant treatment.
  
  
  RESULTS
  In the entire cohort, fluoxetine use was associated with the lowest risk (RR, 0.52; 95% confidence interval [CI], 0.30-0.93), and venlafaxine hydrochloride use with the highest risk (RR, 1.61; 95% CI, 1.01-2.57), of suicide. A substantially lower mortality was observed during selective serotonin reuptake inhibitor use (RR, 0.59; 95% CI, 0.49-0.71; P<.001), and this was attributable to a decrease in cardiovascular- and cerebrovascular-related deaths (RR, 0.42; 95% CI, 0.24-0.71; P=.001). Among subjects who had ever used any antidepressant, the current use of medication was associated with a markedly increased risk of attempted suicide (39%, P<.001), but also with a markedly decreased risk of completed suicide (-32%, P=.002) and mortality (-49%, P<.001), when compared with no current use of medication. The results for subjects aged 10 to 19 years were basically the same as those in the total population, except for an increased risk of death with paroxetine hydrochloride use (RR, 5.44; 95% CI, 2.15-13.70; P<.001).
  
  
  CONCLUSIONS
  Among suicidal subjects who had ever used antidepressants, the current use of any antidepressant was associated with a markedly increased risk of attempted suicide and, at the same time, with a markedly decreased risk of completed suicide and death. Lower mortality was attributable to a decrease in cardiovascular- and cerebrovascular-related deaths during selective serotonin reuptake inhibitor use.
authors.affiliation: Department of Forensic Psychiatry, University of Kuopio and Niuvanniemi Hospital, Kuopio University Hospital, Kuopio, Finland. Jari.Tiihonen@niuva.fi
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.forename: Jouko
authors.initials: J
authors.lastname: Lönnqvist
authors.forename: Kristian
authors.initials: K
authors.lastname: Wahlbeck
authors.forename: Timo
authors.initials: T
authors.lastname: Klaukka
authors.forename: Antti
authors.initials: A
authors.lastname: Tanskanen
authors.forename: Jari
authors.initials: J
authors.lastname: Haukka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002423:Cause of Death; D002648:Child; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors