fbpx
Wikipedia

Antidepressants and suicide risk

March 14, 2024

The relationship between antidepressant use and suicide risk is a subject of medical research and has faced varying levels of debate. This problem was thought to be serious enough to warrant intervention by the U.S. Food and Drug Administration to label greater likelihood of suicide as a risk of using antidepressants.[1] Some studies have shown that the use of certain antidepressants correlate with an increased risk of suicide in some patients relative to other antidepressants.[2] However, these conclusions have faced considerable scrutiny and disagreement: A multinational European study indicated that antidepressants decrease risk of suicide at the population level,[3] and other reviews of antidepressant use claim that there is not enough data to indicate antidepressant use increases risk of suicide.[4][5][6]

Youth edit

Antidepressants could increase the risk of suicidal thoughts and behavior in people with depression under the age of 25. In 2004, the U.S. Food and Drug Administration along with the Neuro-Psychopharmacologic Advisory Committee and the Anti-Infective Drugs Advisory Committee, concluded that there was a causal link between newer antidepressants and pediatric suicidality.[7] Federal health officials unveiled proposed changes to the labels on antidepressant drugs in December 2006 to warn people of this danger.[citation needed]

A 2016 review of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) which looked at four outcomes—death, suicidality, aggressive behaviour, and agitation—found that while the data was insufficient to draw strong conclusions, adults taking these drugs did not appear to be at increased risk for any of the four outcomes, but that for people under the age of 18, the risks of suicidality and for aggression doubled. The authors expressed frustration with incomplete reporting and lack of access to data, and with some aspects of the clinical trial designs, which may have resulted in significant under-reporting of harms.[8]

 
Boxed warning for desvenlafaxine, an SNRI

Warnings edit

The Food and Drug Administration (FDA) requires "black box warnings" on all SSRIs, which state that they double suicidal ideation rates (from 2 in 1,000 to 4 in 1,000) in children and adolescents.[9] It remains controversial whether increased risk of suicide is due to the medication (a paradoxical effect) or part of the depression itself (i.e. the antidepressant enables those who are severely depressed—who ordinarily would be paralyzed by their depression—to become more alert and act out suicidal urges before being fully recovered from their depressive episode).[10] The increased risk for suicidality and suicidal behaviour among adults under 25 approaches that seen in children and adolescents.[11] Young patients should be closely monitored for signs of suicidal ideation or behaviors, especially in the first eight weeks of therapy. Sertraline, tricyclic agents and venlafaxine were found to increase the risk of attempted suicide in severely depressed adolescents on Medicaid.[12]

Increased risk for quitting medication edit

A 2009 study showed increased risk of suicide after initiation, titration, and discontinuation of medication.[13] A study of 159,810 users of either amitriptyline, fluoxetine, paroxetine or dothiepin found that the risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first 1 to 9 days.[14]

Prevalence edit

On September 6, 2007, the Centers for Disease Control and Prevention reported that the suicide rate in American adolescents, (especially girls, 10 to 24 years old), increased 8% (2003 to 2004), the largest jump in 15 years,[15] to 4,599 suicides in Americans ages 10 to 24 in 2004, from 4,232 in 2003, giving a suicide rate of 7.32 per 100,000 people that age. The rate previously dropped to 6.78 per 100,000 in 2003 from 9.48 per 100,000 in 1990. Jon Jureidini, a critic of this study, says that the US "2004 suicide figures were compared simplistically with the previous year, rather than examining the change in trends over several years".[16] It has been noted that the pitfalls of such attempts to infer a trend using just two data points (years 2003 and 2004) are further demonstrated by the fact that, according to the new epidemiological data, the suicide rate in 2005 in children and adolescents actually declined despite the continuing decrease of SSRI prescriptions. "It is risky to draw conclusions from limited ecologic analyses of isolated year-to-year fluctuations in antidepressant prescriptions and suicides.[17]

One promising epidemiological approach involves examining the associations between trends in psychotropic medication use and suicide over time across a large number of small geographic regions. Until the results of more detailed analyses are known, prudence dictates deferring judgment concerning the public health effects of the FDA warnings."[18][19] Subsequent follow-up studies have supported the hypothesis that antidepressant drugs reduce suicide risk.[20][21]

Suicide risk edit

In those under the age of 25 antidepressants appear to increase the risk of suicidal thoughts and behaviors.[22][23] In the United States they contain a black box warning regarding this concern.[22]

A 2016 review found a decreased suicidal events in older adults.[23]

See also edit

References edit

  1. ^ Research, Center for Drug Evaluation and (2018-11-03). "Suicidality in Children and Adolescents Being Treated With Antidepressant Medications". FDA.
  2. ^ C, Coupland; T, Hill; R, Morriss; A, Arthur; M, Moore; J, Hippisley-Cox (2015-02-18). "Antidepressant Use and Risk of Suicide and Attempted Suicide or Self Harm in People Aged 20 to 64: Cohort Study Using a Primary Care Database". BMJ (Clinical Research Ed.). 350: h517. doi:10.1136/bmj.h517. PMC 4353276. PMID 25693810.
  3. ^ Gusmão, Ricardo; Quintão, Sónia; McDaid, David; Arensman, Ella; Van Audenhove, Chantal; Coffey, Claire; Värnik, Airi; Värnik, Peeter; Coyne, James; Hegerl, Ulrich (2013-06-19). "Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study". PLOS ONE. 8 (6): e66455. Bibcode:2013PLoSO...866455G. doi:10.1371/journal.pone.0066455. ISSN 1932-6203. PMC 3686718. PMID 23840475.
  4. ^ G, Isacsson; Cl, Rich (April 2014). "Antidepressant Drugs and the Risk of Suicide in Children and Adolescents". Paediatric Drugs. 16 (2): 115–22. doi:10.1007/s40272-013-0061-1. PMID 24452997. S2CID 904085.
  5. ^ Shain, Benjamin; Adolescence, Committee On (2016-07-01). "Suicide and Suicide Attempts in Adolescents". Pediatrics. 138 (1): e20161420. doi:10.1542/peds.2016-1420. ISSN 0031-4005. PMID 27354459.
  6. ^ C, Adegbite-Adeniyi; B, Gron; Bm, Rowles; Ca, Demeter; Rl, Findling (October 2012). "An Update on Antidepressant Use and Suicidality in Pediatric Depression". Expert Opinion on Pharmacotherapy. 13 (15): 2119–30. doi:10.1517/14656566.2012.726613. PMID 22984934. S2CID 23771296.
  7. ^ Leslie, Laurel K.; Newman, Thomas B.; Chesney, P. Joan; Perrin, James M. (2005). "The Food and Drug Administration's Deliberations on Antidepressant Use in Pediatric Patients". Pediatrics. 116 (1): 195–204. doi:10.1542/peds.2005-0074. PMC 1550709. PMID 15995053.
  8. ^ Sharma, Tarang; Guski, Louise Schow; Freund, Nanna; Gøtzsche, Peter C. (2016-01-27). "Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports". BMJ. 352: i65. doi:10.1136/bmj.i65. ISSN 1756-1833. PMC 4729837. PMID 26819231.
  9. ^ Lenzer, J. (2006). "Antidepressants double suicidality in children, says FDA". BMJ. 332 (7542): 626. doi:10.1136/bmj.332.7542.626-c. PMC 1403224. PMID 16543316.
  10. ^ "SSRI Antidepressants". Patient.info. 2010-10-27. Retrieved 2012-11-30.
  11. ^ Stone, M.; Laughren, T.; Jones, M L.; Levenson, M.; Holland, P C.; Hughes, A.; Hammad, T. A; Temple, R.; Rochester, G. (2009). "Risk of suicidality in clinical trials of antidepressants in adults: Analysis of proprietary data submitted to US Food and Drug Administration". BMJ. 339: b2880. doi:10.1136/bmj.b2880. PMC 2725270. PMID 19671933.
  12. ^ Olfson, Mark; Marcus, Steven; Shaffer, David (Aug 2006). "Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults". Arch Gen Psychiatry. 63 (8): 865–72. doi:10.1001/archpsyc.63.8.865. PMID 16894062.
  13. ^ Valuck, Robert J.; Orton, Heather D.; Libby, Anne M. (2009). "Antidepressant Discontinuation and Risk of Suicide Attempt". The Journal of Clinical Psychiatry. 70 (8): 1069–77. doi:10.4088/JCP.08m04943. PMID 19758520. S2CID 24870988.
  14. ^ Jick, H.; Kaye, JA; Jick, SS (2004). "Antidepressants and the Risk of Suicidal Behaviors". JAMA. 292 (3): 338–43. doi:10.1001/jama.292.3.338. PMID 15265848.
  15. ^ Carey, Benedict (September 7, 2007). "Suicide Rises in Youth; Antidepressant Debate Looms". New York Times.
  16. ^ Jureidini, J. (2007). "The Black Box Warning: Decreased Prescriptions and Increased Youth Suicide?". American Journal of Psychiatry. 164 (12): 1907, author reply 1908–10. doi:10.1176/appi.ajp.2007.07091463. PMID 18056248. S2CID 27774152.
  17. ^ . Archived from the original on 2 April 2015. Retrieved 23 March 2015.
  18. ^ Olfson, M.; Shaffer, D. (2007). "SSRI Prescriptions and the Rate of Suicide". American Journal of Psychiatry. 164 (12): 1907–1908. doi:10.1176/appi.ajp.2007.07091467. PMID 18056247.
  19. ^ Kung HC, Hoyert DL, Xu J, Murphy SL. "N C H S - Health E Stats - Deaths: Preliminary Data for 2005". National Center for Health Statistics. from the original on 12 December 2007. Retrieved 2007-12-12.
  20. ^ Bridge, Jeffrey A.; Iyengar, S; Salary, CB; Barbe, RP; Birmaher, B; Pincus, HA; Ren, L; Brent, DA (2007). "Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment: A Meta-analysis of Randomized Controlled Trials". JAMA. 297 (15): 1683–96. doi:10.1001/jama.297.15.1683. PMID 17440145.
  21. ^ Beasley, Charles M.; Ball, Susan G.; Nilsson, Mary E.; Polzer, John; Tauscher-Wisniewski, Sitra; Plewes, John; Acharya, Nayan (2007). "Fluoxetine and Adult Suicidality Revisited". Journal of Clinical Psychopharmacology. 27 (6): 682–6. doi:10.1097/jcp.0b013e31815abf21. PMID 18004137. S2CID 32153323.
  22. ^ a b "Fluoxetine Hydrochloride Monograph for Professionals". Drugs.com. Retrieved 15 October 2019.
  23. ^ a b Brent, DA (September 2016). "Antidepressants and Suicidality". The Psychiatric Clinics of North America. 39 (3): 503–12. doi:10.1016/j.psc.2016.04.002. PMID 27514302.

Further reading edit

  • Fergusson D, Doucette S, Cranley-Glass K (2005). "The association between suicide attempts and SSRIs: A systematic review of 677 randomised controlled trials representing 85,470 participants". British Medical Journal. 330 (7488): 396–399. doi:10.1136/bmj.330.7488.396. PMC 549110. PMID 15718539.
  • Healy D, Herxheimer A, Menkes D (2006). Antidepressants and violence: Problems at the interface of medicine and law. PLoS Medicine 3, September
  • Healy D, Harris M, Tranter R, Gutting P, Austin R, Jones-Edwards G, Roberts AP (2006). Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared. British Journal of Psychiatry 188, 223–228. With Commentary by T Turner, 229–230.
  • Reseland S, Le Noury J, Aldred G (2008). "National suicide rates 1961–2003: further analysis of Nordic data for suicide, autopsies and ill-defined death rates". Psychotherapy and Psychosomatics. 77 (2): 78–82. doi:10.1159/000112884. PMID 18230940. S2CID 23306023.
  • Healy D, Brent D (2009). "Are Selective Serotonin Reuptake Inhibitors a risk factor for adolescent suicides?". Canadian Journal of Psychiatry. 54 (2): 69–71. doi:10.1177/070674370905400201. PMID 19254434.
  • Healy D (2011). "Science, rhetoric and the causality of adverse events". International Journal of Risk & Safety in Medicine. 23 (3): 149–162. doi:10.3233/JRS-2011-0534. PMID 22020395. S2CID 41674770.

External links edit

  • from the National Institutes of Health

March 14, 2024
antidepressants, suicide, risk, this, article, lead, section, short, adequately, summarize, points, please, consider, expanding, lead, provide, accessible, overview, important, aspects, article, march, 2014, relationship, between, antidepressant, suicide, risk. This article s lead section may be too short to adequately summarize the key points Please consider expanding the lead to provide an accessible overview of all important aspects of the article March 2014 The relationship between antidepressant use and suicide risk is a subject of medical research and has faced varying levels of debate This problem was thought to be serious enough to warrant intervention by the U S Food and Drug Administration to label greater likelihood of suicide as a risk of using antidepressants 1 Some studies have shown that the use of certain antidepressants correlate with an increased risk of suicide in some patients relative to other antidepressants 2 However these conclusions have faced considerable scrutiny and disagreement A multinational European study indicated that antidepressants decrease risk of suicide at the population level 3 and other reviews of antidepressant use claim that there is not enough data to indicate antidepressant use increases risk of suicide 4 5 6 Contents 1 Youth 2 Warnings 3 Increased risk for quitting medication 4 Prevalence 5 Suicide risk 6 See also 7 References 8 Further reading 9 External linksYouth editAntidepressants could increase the risk of suicidal thoughts and behavior in people with depression under the age of 25 In 2004 the U S Food and Drug Administration along with the Neuro Psychopharmacologic Advisory Committee and the Anti Infective Drugs Advisory Committee concluded that there was a causal link between newer antidepressants and pediatric suicidality 7 Federal health officials unveiled proposed changes to the labels on antidepressant drugs in December 2006 to warn people of this danger citation needed A 2016 review of selective serotonin reuptake inhibitors SSRIs and serotonin norepinephrine reuptake inhibitors SNRIs which looked at four outcomes death suicidality aggressive behaviour and agitation found that while the data was insufficient to draw strong conclusions adults taking these drugs did not appear to be at increased risk for any of the four outcomes but that for people under the age of 18 the risks of suicidality and for aggression doubled The authors expressed frustration with incomplete reporting and lack of access to data and with some aspects of the clinical trial designs which may have resulted in significant under reporting of harms 8 nbsp Boxed warning for desvenlafaxine an SNRIWarnings editThe Food and Drug Administration FDA requires black box warnings on all SSRIs which state that they double suicidal ideation rates from 2 in 1 000 to 4 in 1 000 in children and adolescents 9 It remains controversial whether increased risk of suicide is due to the medication a paradoxical effect or part of the depression itself i e the antidepressant enables those who are severely depressed who ordinarily would be paralyzed by their depression to become more alert and act out suicidal urges before being fully recovered from their depressive episode 10 The increased risk for suicidality and suicidal behaviour among adults under 25 approaches that seen in children and adolescents 11 Young patients should be closely monitored for signs of suicidal ideation or behaviors especially in the first eight weeks of therapy Sertraline tricyclic agents and venlafaxine were found to increase the risk of attempted suicide in severely depressed adolescents on Medicaid 12 Increased risk for quitting medication editA 2009 study showed increased risk of suicide after initiation titration and discontinuation of medication 13 A study of 159 810 users of either amitriptyline fluoxetine paroxetine or dothiepin found that the risk of suicidal behavior is increased in the first month after starting antidepressants especially during the first 1 to 9 days 14 Prevalence editOn September 6 2007 the Centers for Disease Control and Prevention reported that the suicide rate in American adolescents especially girls 10 to 24 years old increased 8 2003 to 2004 the largest jump in 15 years 15 to 4 599 suicides in Americans ages 10 to 24 in 2004 from 4 232 in 2003 giving a suicide rate of 7 32 per 100 000 people that age The rate previously dropped to 6 78 per 100 000 in 2003 from 9 48 per 100 000 in 1990 Jon Jureidini a critic of this study says that the US 2004 suicide figures were compared simplistically with the previous year rather than examining the change in trends over several years 16 It has been noted that the pitfalls of such attempts to infer a trend using just two data points years 2003 and 2004 are further demonstrated by the fact that according to the new epidemiological data the suicide rate in 2005 in children and adolescents actually declined despite the continuing decrease of SSRI prescriptions It is risky to draw conclusions from limited ecologic analyses of isolated year to year fluctuations in antidepressant prescriptions and suicides 17 One promising epidemiological approach involves examining the associations between trends in psychotropic medication use and suicide over time across a large number of small geographic regions Until the results of more detailed analyses are known prudence dictates deferring judgment concerning the public health effects of the FDA warnings 18 19 Subsequent follow up studies have supported the hypothesis that antidepressant drugs reduce suicide risk 20 21 Suicide risk editIn those under the age of 25 antidepressants appear to increase the risk of suicidal thoughts and behaviors 22 23 In the United States they contain a black box warning regarding this concern 22 A 2016 review found a decreased suicidal events in older adults 23 See also editCitalopram Paradoxical effectReferences edit Research Center for Drug Evaluation and 2018 11 03 Suicidality in Children and Adolescents Being Treated With Antidepressant Medications FDA C Coupland T Hill R Morriss A Arthur M Moore J Hippisley Cox 2015 02 18 Antidepressant Use and Risk of Suicide and Attempted Suicide or Self Harm in People Aged 20 to 64 Cohort Study Using a Primary Care Database BMJ Clinical Research Ed 350 h517 doi 10 1136 bmj h517 PMC 4353276 PMID 25693810 Gusmao Ricardo Quintao Sonia McDaid David Arensman Ella Van Audenhove Chantal Coffey Claire Varnik Airi Varnik Peeter Coyne James Hegerl Ulrich 2013 06 19 Antidepressant Utilization and Suicide in Europe An Ecological Multi National Study PLOS ONE 8 6 e66455 Bibcode 2013PLoSO 866455G doi 10 1371 journal pone 0066455 ISSN 1932 6203 PMC 3686718 PMID 23840475 G Isacsson Cl Rich April 2014 Antidepressant Drugs and the Risk of Suicide in Children and Adolescents Paediatric Drugs 16 2 115 22 doi 10 1007 s40272 013 0061 1 PMID 24452997 S2CID 904085 Shain Benjamin Adolescence Committee On 2016 07 01 Suicide and Suicide Attempts in Adolescents Pediatrics 138 1 e20161420 doi 10 1542 peds 2016 1420 ISSN 0031 4005 PMID 27354459 C Adegbite Adeniyi B Gron Bm Rowles Ca Demeter Rl Findling October 2012 An Update on Antidepressant Use and Suicidality in Pediatric Depression Expert Opinion on Pharmacotherapy 13 15 2119 30 doi 10 1517 14656566 2012 726613 PMID 22984934 S2CID 23771296 Leslie Laurel K Newman Thomas B Chesney P Joan Perrin James M 2005 The Food and Drug Administration s Deliberations on Antidepressant Use in Pediatric Patients Pediatrics 116 1 195 204 doi 10 1542 peds 2005 0074 PMC 1550709 PMID 15995053 Sharma Tarang Guski Louise Schow Freund Nanna Gotzsche Peter C 2016 01 27 Suicidality and aggression during antidepressant treatment systematic review and meta analyses based on clinical study reports BMJ 352 i65 doi 10 1136 bmj i65 ISSN 1756 1833 PMC 4729837 PMID 26819231 Lenzer J 2006 Antidepressants double suicidality in children says FDA BMJ 332 7542 626 doi 10 1136 bmj 332 7542 626 c PMC 1403224 PMID 16543316 SSRI Antidepressants Patient info 2010 10 27 Retrieved 2012 11 30 Stone M Laughren T Jones M L Levenson M Holland P C Hughes A Hammad T A Temple R Rochester G 2009 Risk of suicidality in clinical trials of antidepressants in adults Analysis of proprietary data submitted to US Food and Drug Administration BMJ 339 b2880 doi 10 1136 bmj b2880 PMC 2725270 PMID 19671933 Olfson Mark Marcus Steven Shaffer David Aug 2006 Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults Arch Gen Psychiatry 63 8 865 72 doi 10 1001 archpsyc 63 8 865 PMID 16894062 Valuck Robert J Orton Heather D Libby Anne M 2009 Antidepressant Discontinuation and Risk of Suicide Attempt The Journal of Clinical Psychiatry 70 8 1069 77 doi 10 4088 JCP 08m04943 PMID 19758520 S2CID 24870988 Jick H Kaye JA Jick SS 2004 Antidepressants and the Risk of Suicidal Behaviors JAMA 292 3 338 43 doi 10 1001 jama 292 3 338 PMID 15265848 Carey Benedict September 7 2007 Suicide Rises in Youth Antidepressant Debate Looms New York Times Jureidini J 2007 The Black Box Warning Decreased Prescriptions and Increased Youth Suicide American Journal of Psychiatry 164 12 1907 author reply 1908 10 doi 10 1176 appi ajp 2007 07091463 PMID 18056248 S2CID 27774152 Adverse Effects of Anti depressants Archived from the original on 2 April 2015 Retrieved 23 March 2015 Olfson M Shaffer D 2007 SSRI Prescriptions and the Rate of Suicide American Journal of Psychiatry 164 12 1907 1908 doi 10 1176 appi ajp 2007 07091467 PMID 18056247 Kung HC Hoyert DL Xu J Murphy SL N C H S Health E Stats Deaths Preliminary Data for 2005 National Center for Health Statistics Archived from the original on 12 December 2007 Retrieved 2007 12 12 Bridge Jeffrey A Iyengar S Salary CB Barbe RP Birmaher B Pincus HA Ren L Brent DA 2007 Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment A Meta analysis of Randomized Controlled Trials JAMA 297 15 1683 96 doi 10 1001 jama 297 15 1683 PMID 17440145 Beasley Charles M Ball Susan G Nilsson Mary E Polzer John Tauscher Wisniewski Sitra Plewes John Acharya Nayan 2007 Fluoxetine and Adult Suicidality Revisited Journal of Clinical Psychopharmacology 27 6 682 6 doi 10 1097 jcp 0b013e31815abf21 PMID 18004137 S2CID 32153323 a b Fluoxetine Hydrochloride Monograph for Professionals Drugs com Retrieved 15 October 2019 a b Brent DA September 2016 Antidepressants and Suicidality The Psychiatric Clinics of North America 39 3 503 12 doi 10 1016 j psc 2016 04 002 PMID 27514302 Further reading editFergusson D Doucette S Cranley Glass K 2005 The association between suicide attempts and SSRIs A systematic review of 677 randomised controlled trials representing 85 470 participants British Medical Journal 330 7488 396 399 doi 10 1136 bmj 330 7488 396 PMC 549110 PMID 15718539 Healy D Herxheimer A Menkes D 2006 Antidepressants and violence Problems at the interface of medicine and law PLoS Medicine 3 September Healy D Harris M Tranter R Gutting P Austin R Jones Edwards G Roberts AP 2006 Lifetime suicide rates in treated schizophrenia 1875 1924 and 1994 1998 cohorts compared British Journal of Psychiatry 188 223 228 With Commentary by T Turner 229 230 Reseland S Le Noury J Aldred G 2008 National suicide rates 1961 2003 further analysis of Nordic data for suicide autopsies and ill defined death rates Psychotherapy and Psychosomatics 77 2 78 82 doi 10 1159 000112884 PMID 18230940 S2CID 23306023 Healy D Brent D 2009 Are Selective Serotonin Reuptake Inhibitors a risk factor for adolescent suicides Canadian Journal of Psychiatry 54 2 69 71 doi 10 1177 070674370905400201 PMID 19254434 Healy D 2011 Science rhetoric and the causality of adverse events International Journal of Risk amp Safety in Medicine 23 3 149 162 doi 10 3233 JRS 2011 0534 PMID 22020395 S2CID 41674770 External links editmessage about antidepressants and suicide in youth from the National Institutes of Health Retrieved from https en wikipedia org w index php title Antidepressants and suicide risk amp oldid 1188118806, wikipedia, wiki, book, books, library,

article

, read, download, free, free download, mp3, video, mp4, 3gp, jpg, jpeg, gif, png, picture, music, song, movie, book, game, games.