Suicide Risk Greatest One Month After Starting Antidepressants

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Suicide Risk Greatest One Month After Starting Antidepressants

By Gardner

HealthDay Reporter

TUESDAY, July 20 (HealthDayNews) -- The first month after someone starts

taking antidepressants is the most risky when it comes to suicidal behavior,

but that danger is no greater with selective serotonin reuptake inhibitors

(SSRIs), new research finds.

This held true among adults as well as youngsters aged 10 to 19, although

the results were more limited for children, according to the study in the

July 21 issue of the Journal of the American Medical Association.

Although no one knows for sure, a likely explanation for this initial

elevated risk -- at its most pronounced from one to nine days -- is that the

patient was still depressed while the medication had not yet taken effect,

the researchers said.

" One possible explanation is that when somebody finally goes to see their

doctor, they're at the height of depression and in an extremely vulnerable

place, and it takes antidepressants a while to take effect, " said study

co-author Jick, an associate professor of epidemiology at Boston

University School of Public Health.

" The public health implication is that you need to be monitoring these

patients carefully in the first nine days [and] several weeks after that, "

added Jick, co-director of the Boston Collaborative Drug Surveillance

Program in Lexington, Mass.

Much attention has been focused recently on whether antidepressants,

especially SSRIs, increase the risk of suicidal thoughts and behaviors in

individuals, particularly teenagers.

The controversy led the U.S. Food and Drug Administration recently to ask

manufacturers of 10 different antidepressants to include a new warning

section and British authorities to issue warnings against SSRI use in

children.

Jick and her colleagues reviewed data on 159,810 people from the United

Kingdom General Practice Research Database (GPRD) who were first-time users

of four antidepressants most commonly used in that country during the 1990s:

amitriptyline (brand name Elavil), fluoxetine (brand name Prozac),

paroxetine (Paxil), and dothiepin. The researchers then cross-referenced use

of the drugs to reports of suicide attempts or successful suicides.

Amitriptyline and dothiepin are older medicines called tricyclics, while

fluoxetine and paroxetine are SSRIs. Dothiepin is not available in the

United States.

The study subjects were aged 10 to 69 but most were over the age of 20, Jick

said.

The risk of suicidal behavior was similar for all four drugs. But it was

almost three times as likely to occur during the first month of use and four

times as likely in the first one to nine days as after the first three

months.

" It seems reasonable to recognize that since medicines take a while to work,

giving someone an antidepressant for the first few weeks, it's as though

they're not being treated and therefore they're at significant risk, " said

Dr. Harold Koplewicz, director of the New York University Child Study

Center. " Depression puts people at risk for suicide. "

There was a slightly higher risk among people on paroxetine, but this drug

is newer and may have been used in people who were more seriously depressed,

the authors said.

There was no difference in risk among younger people (aged 10 to 19), but

the number of people in this age group was small.

" This [study] is certainly not the final word, but what we're trying to do

is shed some light on a situation where the anxiety level has gotten very

high, " Jick said. " I think this is very reassuring, especially in relation

to the teenage population. There were no cases of suicide among all the

teenagers who used the antidepressant drugs. "

The entire database contained 15 teenage suicides between 1993 and 1999, but

none of those children had ever taken antidepressants.

" The big concern is that these drugs are causing teenagers to go out and

kill themselves, " Jick said. " We don't see that in these data and that has

to be reassuring. "