Study questions SSRI link to suicide

Washington -- Antidepressants, particularly selective serotonin reuptake inhibitors, appear to lower the risk of suicide among adults and adolescents being treated for depression, according to a study in the January American Journal of Psychiatry.

The finding addresses concerns raised two years ago that the antidepressants Paxil (paroxetine hydrochloride) and Zoloft (sertraline hydrochloride), as well as others in their class, were responsible for increased risk of suicide attempts, especially among adolescents. The concerns resulted in black-box warnings for the SSRIs as well as a decrease in use.

The study, "Suicide risk during antidepressant treatment," examined 65,103 patients in a large health plan who filled prescriptions for antidepressants between 1992 and 2003.

The findings indicate that there was a decrease in suicide rates, not an increase, during the months following treatment with a range of antidepressant drugs, said Robert Freedman, MD, editor-in-chief of the psychiatric journal.

Nonetheless, the FDA's cautions calling for close monitoring of patients on the drugs should still be taken seriously, he said. "There are some people who become impulsive on these drugs. And that impulse can include suicide."

The study found that there were 314 suicide attempts per 100,000 children and adolescents and 78 attempts per 100,000 adults during the first six months of treatment with antidepressants. But the rate of attempted suicides was highest in the month before treatment began and declined by about 60% afterward, the researchers said. In addition, the risk of suicide was greater for treatment with older antidepressants, such as the tricyclic drugs, when compared with the newer SSRIs.

The findings are consistent with previous reports, said David Fassler, MD, clinical professor of psychiatry at the University of Vermont College of Medicine. "There is no evidence to suggest that SSRI antidepressants increase the risk of suicide. On the contrary, we know that access to comprehensive and appropriate treatment reduces the risk of suicide in patients with depression."