Monday, November 29, 2010

Antidepressants and Suicide Redux

On my post of July 19, Do Antidepressants Cause Suicide, I listed several reasons why antidepressants might increase suicidal ideation in some adult patients.  (I was not talking about children or adolescents since clinical trials in those populations have taken place only rarely). 

Now comes a huge study of adults and antidepressants out of Germany (Stubner, S et. al, "Suicidality as Rare Adverse Event of Antidepressant Medication," Journal of Clinical Psychiatry 71:10, p.1293).  The dataset from the European drug surveillance program was reviewed for patients on inpatient psychiatric units.  142,090 of these patients had taken antidpressants.

Of this ginormous sample, only 33 incidents of suicidality were documented.  12 of these consisted of suicidal ideas only, 18 were actual suicide attempts, and 3 people successfully completed the act.  14 of the 33 cases seemed to be probably, and 19 definitely, related to the medication.  Consistent with my earlier blog post, fully 23 of these 33 of these cases were associated with restlessness.  This is most probably a side effect of antidepressants, and it is one which is completely and very easily treatable.

The authors concluded that antidepressants rarely trigger suicidality, although even this conclusion is hard to be sure of since the attempters were not assessesed at all for psychological, social, or environmental events which might have contributed to their suidality.

Even assuming that a drug was the only cause of the suicide attempts, just 10 patients in this large sample made attempts that were seemingly unrelated to a common and treatable side effect.  10 out of 142,090.  This was in hospitalized patients, who in general tend to be have more serious symptoms and have far more suicidal ideation than comparable outpatients.

The risk therefore is .007 percent in this population.  And that's a maybe.  That is roughly one third of the minimum estimate of the risk of death from having liposuction for cosmetic surgery.

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