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, 18 February 2015

This cohort study aims to assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression.

238 963 patients registered with UK general practices aged 20 to 64 years with a first diagnosis of depression participated between 1 January 2000 and 31 July 2011, followed up until 1 August 2012.

The study concludes that rates of suicide and attempted suicide or self harm were similar during periods of treatment with selective serotonin reuptake inhibitors and tricyclic and related antidepressants. Mirtazapine, venlafaxine, and trazodone were associated with the highest rates of suicide and attempted suicide or self harm, but the number of suicide events was small leading to imprecise estimates. As this is an observational study the findings may reflect indication biases and residual confounding from severity of depression and differing characteristics of patients prescribed these drugs. The increased rates in the first 28 days of starting and stopping antidepressants emphasise the need for careful monitoring of patients during these periods.

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