title: Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review.
abstract: OBJECTIVE
  To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case-control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included.
  
  
  METHODS
  The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study.
  
  
  RESULTS
  Of 11,792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity.
  
  
  CONCLUSIONS
  Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses.
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.
authors.forename: Hayley C
authors.initials: HC
authors.lastname: Gorton
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Roger T
authors.initials: RT
authors.lastname: Webb
authors.affiliation: Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
authors.forename: Navneet
authors.initials: N
authors.lastname: Kapur
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Ashcroft
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D002317:Cardiovascular Agents / Q000009:adverse effects; D006801:Humans; D015474:Isotretinoin / Q000009:adverse effects; D020024:Leukotriene Antagonists / Q000009:adverse effects; D064887:Observational Studies as Topic; D055553:Prescription Drugs / Q000009:adverse effects*; D012306:Risk; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted; D000068580:Varenicline / Q000009:adverse effects
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D002317:Cardiovascular Agents; D020024:Leukotriene Antagonists; D055553:Prescription Drugs; D015474:Isotretinoin; D000068580:Varenicline
keywords: EPIDEMIOLOGY; MENTAL HEALTH