Antidepressant Medications No Longer Linked to Suicide Attempts

[July 2007] Suicide attempts dropped among people with depression soon after they started treatment, either with antidepressant drugs or psychotherapy, a study of more than 109,000 patients shows.

The study results come after a controversial 2004 recommendation on antidepressant labeling from the US Food and Drug Administration (FDA). That move required a strong "black box" warning on the labeling of drugs called selective serotonin reuptake inhibitors (SSRIs), which include CelexaTM, PaxilTM, ProzacTM, and ZoloftTM.

A black box warning is a prominent medication-label alert for high risk prescription drugs that may cause serious injuries or death.

The warning outlined the potential for an increase in suicidal thoughts among teenagers and young adults who were prescribed the medications. The warning also urged closer clinical monitoring of these patients.

Black Box Warning Based on Insufficient Data

However, "the FDA warning was based on placebo-controlled trials," notes lead researcher Dr. Greg Simon, a psychiatrist and researcher at Group Health, a Seattle-based nonprofit health care system. "They did not look at suicide attempts, because they were too rare. In the whole group of studies the FDA looked at, there were only two suicide attempts," Dr. Simon says.

The current trial, published in the American Journal of Psychiatry, does focus on suicide attempts. It finds that pharmaceutical and psychotherapy treatments aimed at fighting depression reduce those attempts.

Predictable Pattern for Attempts

Dr. Simon's study looked at suicide attempts among more than 70,000 people who got an antidepressant prescription from their primary care physicians, almost 7,300 people who got prescriptions from a psychiatrist, and more than 54,000 who started psychotherapy for the treatment of depression.

"The pattern of [suicide] attempts over time was the same in all three groups: highest in the month before starting treatment, next highest in the month after starting treatment, and declining thereafter," the report says. This supports the fact that suicide attempts often precipitate a referral for treatment.

"Results were unchanged after eliminating patients receiving overlapping treatment with medication and psychotherapy. Overall incidence of suicide attempts was higher in adolescents and young adults, but the time pattern was the same across all three treatments," according to the researchers. 

Treatment Helps Depression

The overall incidence of suicide attempts in the first six months was highest in those taking antidepressant drugs prescribed by a psychiatrist (1,124 attempts per 100,000), lower among those starting psychotherapy (778 per 100,000) and lowest of all among those who were taking antidepressants prescribed by a general practitioner (301 per 100,000).

The lower attempt rates among those starting psychotherapy or seeing a general practitioner could be related to less severe illness.

"Our study indicates that there's nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves - or protect them from suicidal thoughts," says Dr. Simon.  "Instead, we think that, on average, starting any type of treatment - medications, psychotherapy, or both - helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it."

Experts agree that regularly monitoring patients during treatment with antidepressants helps to ensure that they are receiving the right medication at a dose that helps them feel better. "If people feel agitated or suicidal, they should seek help from a doctor or therapist," according to Dr. Simon.

Always consult your physician for more information.