Tuesday, 18 August 2009

Suicide risk with anti-depressants depends on age

Can anti-depressants increase your suicide risk? New research published in the British Medical Journal should help clarify the risk.

According to the study of data submitted to US Food and Drug Administration on nearly 100,000 adults, the risk of suicide associated with antidepressants is strongly age dependent – the risk is raised in people under 25, not affected in those aged 25-64, and reduced in those aged 65 and older, say the authors.

Of course, even with such a large sample, there were still relatively few sucides which means the findings still need to be treated with caution. The study showed eight completed suicides, 134 suicide attempts, 10 patients who had made preparations without attempting suicide, and 378 patients who had thoughts about suicide but had not acted on them.

There are also, according to an accompanying editorial in the Journal, considerable variations between drugs especially among the selective serotonin reuptake inhibitors (SSRIs) type of drug. Again caution is urged but the editorial, by John Geddes, the professor of epidemiological psychiatry at the University of Oxford concludes that sertraline (trade names Zoloft and Lustral) and escitalopram (trade names Lexapro and Cipralex) 'have the best balance of short term efficacy and tolerability'.

FDA upgrade warnings

Previous studies have shown that antidepressant drugs are linked with an increased risk of suicidal behaviour and thoughts in children and adolescents, particularly in the early stages of treatment. These findings also support the idea that antidepressant drugs can have two separate effects on adults:

• an undesirable effect in some patients that promotes suicidal thoughts or behaviour, with a risk that appears to diminish with age, and
• a protective effect in others that alleviates depression and reduces any suicidal risk.

This should be the subject of further research, particularly in terms of possible mechanisms for age related differences, say the authors.

In 2005, the US Federal Drugs Administration added a black box warning to antidepressants. It has now expanded the suicide warning on antidepressant drugs with this new information, including the strong age relatedness of the findings. 

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