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. 2005 Feb 19;330(7488):389.
doi: 10.1136/bmj.330.7488.389.

Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study

Carlos Martinez  1 , Stephan Rietbrock, Lesley Wise, Deborah Ashby, Jonathan Chick, Jane Moseley, Stephen Evans, David Gunnell
Affiliations

Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study

Carlos Martinez et al. BMJ. .

Abstract

Objective: To compare the risk of non-fatal self harm and suicide in patients taking selective serotonin reuptake inhibitors (SSRIs) with that of patients taking tricyclic antidepressants, as well as between different SSRIs and different tricyclic antidepressants.

Design: Nested case-control study.

Setting: Primary care in the United Kingdom.

Participants: 146,095 individuals with a first prescription of an antidepressant for depression.

Main outcome measures: Suicide and non-fatal self harm.

Results: 1968 cases of non-fatal self harm and 69 suicides occurred. The overall adjusted odds ratio of non-fatal self harm was 0.99 (95% confidence interval 0.86 to 1.14) and that of suicide 0.57 (0.26 to 1.25) in people prescribed SSRIs compared with those prescribed tricyclic antidepressants. We found little evidence that associations differed over time since starting or stopping treatment. We found some evidence that risks of non-fatal self harm in people prescribed SSRIs compared with those prescribed tricyclic antidepressants differed by age group (interaction P = 0.02). The adjusted odds ratio of non-fatal self harm for people prescribed SSRIs compared with users of tricylic antidepressants for those aged 18 or younger was 1.59 (1.01 to 2.50), but no association was apparent in other age groups. No suicides occurred in those aged 18 or younger currently or recently prescribed tricyclic antidepressants or SSRIs.

Conclusion: We found no evidence that the risk of suicide or non-fatal self harm in adults prescribed SSRIs was greater than in those prescribed tricyclic antidepressants. We found some weak evidence of an increased risk of non-fatal self harm for current SSRI use among those aged 18 or younger. However, preferential prescribing of SSRIs to patients at higher risk of suicidal behaviour cannot be ruled out.

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Figures

Fig 1
Fig 1
Risk of non-fatal self harm in patients aged 10-18 currently exposed to citalopram, fluoxetine, fluvoxamine, and sertraline compared with paroxetine
See this image and copyright information in PMC

Comment in

  • Suicide, depression, and antidepressants.
    Cipriani A, Barbui C, Geddes JR. Cipriani A, et al. BMJ. 2005 Feb 19;330(7488):373-4. doi: 10.1136/bmj.330.7488.373. BMJ. 2005. PMID: 15718515 Free PMC article. No abstract available.

References

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    1. Medawar C, Herxheimer A, Bell A, Jofre S. Paroxetine, Panorama and user reporting of ADRs: Consumer intelligence matters in clinical practice and post-marketing drug surveillance. Int J Risk Saf Med 2002;15: 161-9.
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    1. Gunnell D, Ashby D. Antidepressants and suicide: what is the balance of benefit and harm. BMJ 2004;329: 34-8. - PMC - PubMed
    1. Anonymous. SSRI and venlafaxine use in children. Curr Probl Pharmacovigilance 2003;29: 4.

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