Are Some Antidepressants Safer Than Others Regarding Suicide Risk?
Am Fam Physician. 2015 Jul 1;92(1):52a-54.
Are some antidepressants safer than others regarding suicide risk?
Mirtazapine (Remeron) and venlafaxine are associated with higher rates of completed suicide in primary care patients. Rates of suicide attempts and completion are similar with the use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. (Level of Evidence = 2b)
These U.K.-based researchers used Qresearch, a large primary care database of more than 12 million patients from 600 general practices, to identify 238,963 patients with a new diagnosis of depression. Most patients (87.7%) received a prescription for an antidepressant and most of these prescriptions (71.3%) were for an SSRI. The mean duration of treatment was 221 days. During the first five years of follow-up, the authors identified 198 cases of suicide and 5,243 cases of attempted suicide or self-harm. Suicide rates were higher in the first 28 days of treatment. Absolute risks of suicide over one year ranged from 0.02% for amitriptyline to 0.19% for mirtazapine. There was no difference in suicide rates or rates of attempted suicide/self-harm between patients treated with SSRIs and tricyclic and related antidepressants. Compared with citalopram (Celexa), rates of suicide were significantly increased with mirtazapine (hazard ratio [HR] = 3.70; 95% confidence interval [CI], 2.00 to 6.84) and venlafaxine (HR = 2.23; 95% CI, 1.14 to 4.39). Other studies have shown similar suicide rates between SSRIs and tricyclic antidepressants (Am J Psychiatry. 2003;160(4):790–792).
Study design: Cohort (retrospective)
Funding source: Government
Setting: Outpatient (any)
Reference: Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J. 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. 2015; 350: h517.
POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.
For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.
To subscribe to a free podcast of these and other POEMs that appear in AFP,search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.
This series is coordinated by Sumi Sexton, MD, Associate Medical Editor.
A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Dec 15, 2018
Access the latest issue of American Family Physician