Monday, December 4, 2006

Suicidal patients taking antidepressants have a “markedly increased” risk of additional suicide attempts but a “markedly decreased” risk of dying from suicide, a large Finnish study has found.

The research into nearly 15,400 patients hospitalized for suicide attempts between 1997 and 2003 showed that “current antidepressant use was associated with a 39 percent increase in risk of attempted suicide, but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause,” the authors wrote in a report published in the Dec. 4 issue of Archives of General Psychiatry.

Dr. Jari Tiihonen and colleagues at the University of Kuopio and Niuvanniemi Hospital in Kuopio, Finland, pointed out that major depression is the “most important risk factor for suicidal behavior” but that the role of antidepressant medications in preventing or causing suicide has been uncertain.

Until now, they said, “it has not been possible to demonstrate that the use of antidepressant medication decreases the risk of suicide,” despite extensive research.

Much of the debate over this question has focused on a category of relatively new but widely used antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Last year, the Food and Drug Administration issued a “black-box warning” — the most serious type in prescription-drug labeling — for all SSRIs. The administration says the drugs have the potential to promote suicidal thoughts in children. It also advises close monitoring of all patients taking SSRIs, after some recent scientific reports warned that adults receiving these medications also may be at increased risk for suicidal behavior.

The Finnish study analyzed 15,390 suicidal patients of all ages for an average of 3.4 years. The authors said they did this “because previous suicide attempts are the most important risk factor for predicting suicide.”

Among the 7,466 males and 7,924 females examined, there were 602 suicides, 7,136 suicide attempts requiring hospitalization and 1,583 deaths recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants.

As for why using antidepressants seem to increase nonfatal suicide behavior, researchers said this may be explained “by a decrease in the incidence of violent and more fatal methods of suicide attempts, such as hanging and shooting.”

But the picture was not so bright for all those who took SSRIs. It was for those taking fluoxetine (Prozac), who had a 48 percent lower risk of suicide than those not taking medication. But the study found that those taking another SSRI, venlafaxine hydrochloride (Effexor XR), had a 61 percent increased risk.

The authors said the study’s overall findings that those taking antidepressants were at a lower risk for suicides or other causes of death than those not being treated with medications were “basically the same” for people ages 10 to 19 as those in the total population. The one exception, they said, was “an increased risk of death” with paroxetine hydrochloride (Paxil) among youth in the study.

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