Medline ® Abstracts for References 14-18
of 'Effect of antidepressants on suicide risk in children and adolescents'
Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis.
Hall WD, Mant A, Mitchell PB, Rendle VA, Hickie IB, McManus P
OBJECTIVE: To examine the association between trends in antidepressant prescribing and suicide rates in Australia for 1991-2000.
DESIGN: Analysis of databases of suicide and rates of antidepressant prescribing according to age and sex.
SETTING: Australian Bureau of Statistics data, sales data from the Australian pharmaceutical industry, prescribing data in general practice.
SUBJECTS: Men and women aged 15 years and over in 10 year age groups.
MAIN OUTCOME MEASURES: Trends in suicide rates and trends in antidepressant prescribing. Association measured by Spearman's rank correlations.
RESULTS: While overall national rates of suicide did not fall significantly, incidencedecreased in older men and women and increased in younger adults. In both men (r(s)=-0.91; P<0.01) and women (r(s)=-0.76; P<0.05) the higher the exposure to antidepressants the larger the decline in rate of suicide.
CONCLUSIONS: Changes in suicide rates and exposure to antidepressants in Australia for 1991-2000 are significantly associated. This effect is most apparent in older age groups, in which rates of suicide decreased substantially in association with exposure to antidepressants. The increase in antidepressant prescribing may be a proxy marker for improved overall management of depression. If so, increased prescribing of selective serotonin reuptake inhibitors in general practice may have produced a quantifiable benefit in population mental health.
Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia.
Relationship between antidepressant medication treatment and suicide in adolescents.
Olfson M, Shaffer D, Marcus SC, Greenberg T
Arch Gen Psychiatry. 2003;60(10):978.
CONTEXT: A decade of increasing antidepressant medication treatment for adolescents and corresponding declines in suicide rates raise the possibility that antidepressants have helped prevent youth suicide.
OBJECTIVE: To evaluate the relationship between regional changes in antidepressant medication treatment and suicide in adolescents from 1990 to 2000.
DESIGN: Analysis of prescription data from the nation's largest pharmacy benefit management organization, national suicide mortality files, regional sociodemographic data from the 1990 and 2000 US Census, and regional data on physicians per capita.
PARTICIPANTS: Youth aged 10 to 19 years who filled a prescription for antidepressant medication and same-aged completed suicides from 588 three-digit ZIP code regions in the United States.
MAIN OUTCOME MEASURES: The relationship between regional change in antidepressant medication treatment and suicide rate stratified by sex, age group, regional median income, and regional racial composition.
RESULTS: There was a significant adjusted negative relationship between regional change in antidepressant medication treatment and suicide during the study period. A 1% increase in adolescent use of antidepressants was associated with a decrease of 0.23 suicide per 100 000 adolescents per year (beta = -.023, t = -5.14, P<.001). In stratified adjusted analyses, significant inverse relationships were present among males (beta = -.032, t = -3.81, P<.001), youth aged 15 to 19 years (beta = -.029, t = -3.43, P<.001), and regions with lower family median incomes (beta = -.023, t = -3.73, P<.001).
CONCLUSIONS: An inverse relationship between regional change in use of antidepressants and suicide raises the possibility of a role for using antidepressant treatment in youth suicide prevention efforts, especially for males, older adolescents, and adolescents who reside in lower-income regions.
Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York 10032, USA. email@example.com
Antidepressant medication and suicide in Sweden.
Carlsten A, Waern M, Ekedahl A, Ranstam J
Pharmacoepidemiol Drug Saf. 2001;10(6):525.
OBJECTIVE: To explore a possible temporal association between changes in antidepressant sales and suicide rates in different age groups.
METHODS: A time series analysis using a two-slope model to compare suicide rates in Sweden before and after introduction of the selective serotonin reuptake inhibitors, SSRIs.
RESULTS: Antidepressant sales increased between 1977-1979 and 1995-1997 in men from 4.2 defined daily doses per 1000 inhabitants and day (DDD/t.i.d) to 21.8 and in women from 8.8 to 42.4. Antidepressant sales were twice as high in the elderly as in the 25-44-year-olds and eight times that in the 15-24-year-olds. During the same time period suicide rates decreased in men from 48.2 to 33.3 per 10(5) inhabitants/year and in women from 20.3 to 13.4. There was significant change in the slope in suicide rates after the introduction of the SSRI, for both men and women, which corresponds to approximately 348 fewer suicides during 1990-1997. Half of these 'saved lives' occurred among young adults.
CONCLUSION: We demonstrate a statisticallysignificant change in slope in suicide rates in men and women that coincided with the introduction of the SSRI antidepressants in Sweden. This change preceded the exponential increase in antidepressant sales.
Department of Social Medicine, University of Göteborg, Sweden. firstname.lastname@example.org
The utilization of antidepressants--a key issue in the prevention of suicide: an analysis of 5281 suicides in Sweden during the period 1992-1994.
Isacsson G, Holmgren P, Druid H, Bergman U
Acta Psychiatr Scand. 1997;96(2):94.
Antidepressants detected by the National Department of Forensic Chemistry in 5281 suicides in Sweden during the period 1992-1994 were related to data on usage expressed in person-years of exposure. Antidepressants were detected in 874 subjects (16.5%). In relation to their use, fluvoxamine, citalopram, moclobemide, mianserin and trimipramine were found more often than the reference drug, amitriptyline (i.e. over-risks). Toxic concentrations of antidepressants were detected in 232 subjects (4.4%). Most people committing suicide were not taking antidepressants immediately before their death, even though 40-85% may have been depressed. Undertreatment and therapeutic failure are the main problems with antidepressants, not the risk of using antidepressants in overdose. Comparisons of new antidepressants should focus on efficacy in relation to reference tricyclics. The huge increase in the use of antidepressants in Sweden since 1990-1991 has been paralleled by a significant decrease in suicide rates.
Department of Clinical Neurosciences and Family Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
The relationship between antidepressant medication use and rate of suicide.
Gibbons RD, Hur K, Bhaumik DK, Mann JJ
Arch Gen Psychiatry. 2005;62(2):165.
BACKGROUND: Approximately 30 000 people die annually by suicide in the United States. Although 60% of suicides occur during a mood disorder, mostly untreated, little is known about the relationship between antidepressant medication use and the rate of suicide in the United States.
OBJECTIVE: To examine the association between antidepressant medication prescription and suicide rate by analyzing associations at the county level across the United States.
DESIGN: Analysis of National Vital Statistics from the Centers for Disease Control and Prevention.
SETTING: All US counties.
PARTICIPANTS: All US individuals who committed suicide between 1996 and 1998.
MAIN OUTCOME MEASURES: National county-level suicide rate data are broken down by age, sex, income, and race for the period of 1996 to 1998. National county-level antidepressant prescription data are expressed as number of pills prescribed. The primary outcome measure is the suicide rate in each county expressed as the number of suicides for a given population size.
RESULTS: The overall relationship between antidepressant medication prescription and suicide rate was not significant. Within individual classes of antidepressants, prescriptions for selective serotonin reuptake inhibitors (SSRIs) and other new-generation non-SSRI antidepressants (eg, nefazodone hydrochloride, mirtazapine, bupropion hydrochloride, and venlafaxine hydrochloride) are associated with lower suicide rates (both within and between counties). A positive association between tricyclic antidepressant (TCA) prescription and suicide rate was observed. Results are adjusted for age, sex, race, income, and county-to-county variability in suicide rates. Higher suicide rates in rural areas are associated with fewer antidepressant prescriptions, lower income, and relatively more prescriptions for TCAs.
CONCLUSIONS: The aggregate nature of these observational data preclude a direct causal interpretation of the results. A high number of TCA prescriptions may be a marker for those counties with more limited access to quality mental health care and inadequate treatment and detection of depression, which in turn lead to increased suicide rates. By contrast, increases in prescriptions for SSRIs and other new-generation non-SSRIs are associated with lower suicide rates both between and within counties over time and may reflect antidepressant efficacy, compliance, a better quality of mental health care, and low toxicity in the event of a suicide attempt by overdose.
Center for Health Statistics, University of Illinois at Chicago, USA.