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. 2007 Feb 3;334(7587):242.
doi: 10.1136/bmj.39041.445104.BE. Epub 2006 Dec 12.

Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study

Annalisa Rubino  1 , Neil Roskell, Pat Tennis, Daniel Mines, Scott Weich, Elizabeth Andrews
Affiliations

Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study

Annalisa Rubino et al. BMJ. .

Abstract

Objective: To compare the risk of suicide in adults using the antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin.

Design: Retrospective cohort study.

Setting: UK General Practice Research Database.

Participants: 219,088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005.

Main outcome measures: Completed suicide and attempted suicide.

Results: Venlafaxine users had a higher burden of risk factors for suicide, including previous suicide attempts and proxies for severe depression or depression that was difficult to treat. In the analysis for completed suicides, unadjusted and adjusted hazard ratios for venlafaxine compared with citalopram were 2.44 (95% confidence interval 1.12 to 5.31) and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetine were 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxine compared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53 to 3.25). Compared with other study drugs, venlafaxine was also associated with an increased risk of attempted suicide, but adjustment for measured confounders substantially reduced the hazard ratios.

Conclusions: Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk.

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Conflict of interest statement

Competing interests: All other authors have no personal financial interest in the drug studies. RTI Health Solutions has received research funding from several companies, including Lilly, GlaxoSmithKline, and Pfizer, who market antidepressants and potentially gain or lose financially from the results of the study.

Comment in

References

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