Antidepressants associated with increased risk for suicide attempts, decreased risk for death

December 04, 2006

Suicidal individuals taking antidepressant medications appear to have an increased risk of additional suicide attempts, but a reduced risk of dying from suicide or any other cause, according to a large Finnish study reported in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

Major depression is one of the most important risk factors for suicidal behavior, according to background information in the article. However, medications used to treat depression have also been linked to suicidal attempts and behavior, especially among children and adolescents taking a type of antidepressant known as selective serotonin reuptake inhibitors (SSRIs). The issue is difficult to study because the number of completed suicides is relatively low; an effective study would have to include tens of thousands of patients and last for several years. "Because previous suicide attempts are the most important risk factor for predicting suicide, a large cohort of suicidal patients would be an obvious choice to investigate the association between antidepressant treatment and the risk of suicide," the authors write.

Jari Tiihonen, M.D., Ph.D., University of Kuopio and Niuvanniemi Hospital, Kuopio, Finland, and colleagues analyzed data from all individuals hospitalized in Finland for suicide attempts between 1997 and 2003. Information about 15,390 hospitalized individuals--including age, sex, location, dates of admission and discharge, number of previous hospitalizations for attempted suicide and antidepressant prescriptions--was gathered through Finnish national registries and databases. The patients were followed for an average of 3.4 years to see if they attempted suicide again, completed suicide or died from another cause.

Among the 7,466 males and 7,924 females in the study, 602 suicides, 7,136 suicide attempts leading to hospitalization and 1,583 deaths were recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants. However, the association varied by antidepressant--individuals taking an SSRI known as fluoxetine had a 48 percent lower risk of suicide (6.7 deaths per 1,000 total years that individuals took the drug) compared with those not taking medication (11 deaths per 1,000 years), while those taking venlafaxine hydrochloride, another SSRI, had a 61 percent increased risk (22.5 suicide deaths per 1,000 total years of medication use). The risk of death from any cause was 31 percent to 41 percent lower among those taking antidepressants. Those taking SSRIs had a 61 percent reduced risk of death compared with those taking no antidepressants, a fact that could be attributed to a reduction in deaths related to cardiovascular disease and stroke.

Patients taking any kind of antidepressant had a 36 percent increased risk of a subsequent suicide attempt leading to hospitalization (204.7 per 1,000 total years of taking medications) compared with those taking no antidepressants (106.2 per 1,000 years); a slightly greater increase in risk was observed among those age 10 to 19 years (132.7 per 1,000 years for those taking antidepressants vs. 82.9 for those not taking antidepressants).

Among those who had ever taken antidepressants, current antidepressant use was associated with a 39 percent increase in risk of attempted suicide but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause. "This opposite type of effect on fatal vs. nonfatal suicidal behavior may be explained by an increased risk of intoxication because of easy availability of means (antidepressant medication), resulting in an increase in nonfatal suicidal behavior, and by a decrease in the incidence of violent and more fatal methods of suicide attempts, such as hanging and shooting," the authors write.
-end-
(Arch Gen Psychiatry. 2006;63:1358-1367. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by annual EVO financing (special government subsidies) from Niuvanniemi Hospital. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

The JAMA Network Journals

Related Suicide Articles from Brightsurf:

Suicide prevention in COVID-19 era
COVID-19 presents a new and urgent opportunity to focus political will, federal investments, and global community on the vital imperative of suicide prevention.

Racial discrimination linked to suicide
New research findings from the University of Houston indicate that racial discrimination is so painful that it is linked to the ability to die by suicide, a presumed prerequisite for being able to take one's own life, and certain mental health tools - like reframing an incident - can help.

Factors associated with firearm suicide risk
Researchers compared the risk of suicide by firearm based on sociodemographic characteristics of US adults.

Suicide mortality and COVID-19
Reasons why U.S. suicide rates may rise in tandem with the coronavirus disease 2019 (COVID-19) pandemic are explained in this article that also describes opportunities to expand research and care.

Media reports of celebrity suicide linked to increased suicide rates
Media reporting of suicide, especially celebrity suicides, is associated with increases in suicide in the general population, particularly by the same method as used by the celebrity, finds an analysis of the latest evidence published by The BMJ today.

More youth suicide found in poor communities across US
A study led by Jennifer Hoffmann, M.D., from Ann & Robert H.

BU study finds new factors linked to suicide
A new study led by Boston University School of Public Health (BUSPH) researchers finds that physical illness and injury raises the risk of suicide in men but not women, along with a plethora of other insights into the complex factors that may increase a person's risk of suicide.

Investigating the full spectrum of suicide
A recent study published in Injury Prevention described a method for categorizing self-injury mortality (SIM) to help us better examine national trends for today's epidemics of suicide and drug-related deaths.

Between 16 and 18% of preadolescents have ideas of suicide
Thinking of taking one's own life (ideation), planning it, threatening to do it or even attempting to do it is regarded as suicidal behaviour.

Social networks and suicide prevention
Depression and mental health problems are increasing - and suicide and drug overdose rates are rising dramatically in the USA.

Read More: Suicide News and Suicide Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.