Suicide risk does not increase when adults start using antidepressants

The risk of serious suicide attempts or death by suicide generally decreases in the weeks after patients start taking antidepressant medication, according to a new study led by Group Health Cooperative researchers and published in the January issue of The American Journal of Psychiatry. The study also found that the risk of suicidal behavior after starting 10 newer antidepressant medications is less than the risk posed by older medications.

These findings challenge a 2004 advisory by the U.S. Food and Drug Administration (FDA), which warned that suicidal behavior may emerge after treatment with the newer antidepressant drugs has begun.

"Our findings show that, fortunately, suicide attempts and death by suicide are rare following the initiation of antidepressants," says Greg Simon, MD, MPH, a Group Health psychiatrist and the lead researcher on the study. "The period right after people start taking antidepressant medication is not a period of increased risk. In fact, risk after starting medication is lower than before."

This study is the first published analysis to compare the risk of suicide attempts before treatment to the risks following treatment. It is based on computerized medical and pharmacy records for more than 65,000 patients who filled prescriptions for antidepressants from 1992 to 2003. Deaths by suicide were determined from death certificates and suicide attempts were identified from hospital discharge data.

Group Health researchers found that the number of suicide attempts fell by 60 percent in adults during the month after antidepressant treatment began, and declined further in the following five months. Among the 65,103 patients taking antidepressants, there were 31 completed suicides in the six months following the antidepressant prescription. That rate was not higher in the one month after the prescription than in subsequent months. The study also found that newer antidepressants were associated with a faster decline in rates of suicidal behavior than older drugs.

Adolescents in the study had more suicide attempts than adults. The researchers found that the rate for the first six months of antidepressant treatment was 314 attempts per 100,000 in teens and 78 attempts per 100,000 in adults. As with adults, the rate was highest in the month before treatment and declined by about 60 percent after treatment began.

Given recent public concern over a possible link between suicide and antidepressants, Simon says he fears people may mistakenly believe that suicidal behavior is common after taking antidepressant medications. That misperception could lead to fewer people with depression being treated with medications proven to be effective in battling depression, he adds.

"There may be subgroups of people who become more agitated or suicidal after taking these drugs, and those people should seek help from a doctor or therapist right away if that happens," says Simon. "But our study showed that on average, the risk of suicide actually goes down after people start taking the antidepressant."

Simon agrees with the FDA's recommendations that doctors carefully monitor people taking antidepressants. "Keeping a close watch on patients after they begin taking these drugs is a good idea--although not because these medicines are especially risky or dangerous," he says. "Patients need to be monitored to ensure they're getting the right medication in the amount that can help them feel better."

From Group Health Cooperative Center for Health Studies