title: [Suicide behavior before and after the start with antidepressants: a high persistent risk in the first month of treatment among the young].
abstract: OBJECTIVE
  A causal relationship between antidepressants (ADs) and high risk of suicide behavior at young age has been suggested. We analyzed the rates of suicide attempts during treatment with AD in comparison with the rates before treatment initiation for different ages.
  
  
  METHODS
  Observational retrospective cohort study.
  
  
  METHODS
  Claims of insurance company Achmea were used to establish the risk of a suicide attempt before and after start of treatment among patients with a first registered AD prescription in 2006-2011 (n = 66,196).
  
  
  RESULTS
  Among those aged < 25 years, a high rate of suicide attempts during the month before the start was found (376.3/10,000 person yrs). A non-significant increase in the first month (p = 0.212) was found and a non-significant trend to lower values thereafter (p = 0.3050). Among those ≥ 25 years, a clear decrease to lower rates immediately after the start was observed (p < 0.025). The highest rates of suicide were found among those > 40 years during the first month. Female gender was, but treatment characteristics were not associated with early attempts at young age.
  
  
  CONCLUSIONS
  Among young AD users, high pre-treatment risk of suicide attempts was present and persisted during the early phases after the start. This contrasted with the clear decrease in risk among those aged ≥ 25 years, suggesting lower immediate effectiveness of ADs to prevent suicidal behavior at young ages. Caution should be exercised to infer a causal relationship or to use data on attempts to predict risk of suicide during AD use.
authors.affiliation: *Dit onderzoek werd eerder gepubliceerd in InternationalJournalofNeuropsychopharmacology (2015; online: 18 juli) met als titel 'Suicide behavior before and after the start with antidepressants: a high persistent risk in the first month of treatment among the young'. Afgedrukt met toestemming.
authors.forename: Fabian
authors.initials: F
authors.lastname: Termorshuizen
authors.forename: Saskia J M
authors.initials: SJ
authors.lastname: Palmen
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink