June 14, 2006

Antidepressants linked to suicide risk in elderly

NEW YORK (Reuters Health) - The risk of suicide among older
patients appears to be increased during the first month of
therapy with selective serotonin reuptake inhibitor (SSRI)
antidepressants, but this increased risk is fairly low,
researchers in Canada report.

Dr. David N. Juurlink, of the Institute for Clinical
Evaluative Sciences, Toronto, and colleagues examined coroner's
data, along with data on prescriptions, physician billing
claims and hospitalization, for more than 1.2 million subjects
who were at least 66 years of age between 1992 and 2000.

A total of 1138 individuals who suicide were identified and
these individuals were closely matched to 4,552 subjects who
served as comparison group, according to the team's report in
the American Journal of Psychiatry.

Compared with other antidepressants, SSRIs were associated
with a nearly fivefold increased risk of completed suicide
during the first month of therapy. In the first 30 days of
treatment, 62 patients on an SSRI committed suicide compared
with 17 suicides among patients who were prescribed another
type of antidepressant drug.

This risk was still seen after factoring in the effects of
a recent depression diagnosis or previous psychiatric care.
Suicide of a violent nature was also more common among patients
on SSRI therapy compared with patients receiving other

However, no increased risk of suicide was observed during
the second and subsequent months of SSRI antidepressant

"Several mechanisms may underlie the association between
SSRI antidepressants and suicide," Juurlink and colleagues

"During initial therapy, the risk of suicide may increase
as some aspects of depression resolve (e.g., psychomotor
retardation), thereby energizing the patient to suicide," they
note. The patients may also develop feelings of restlessness
during SSRI antidepressants, "which may increase the risk of

These findings differ from those reported online this week
in the Public Library of Science Medicine journal. Researchers
compared suicide rates in the U.S. in the last 14 years with
the use of an SSRI antidepressant during the same period. They
found that as the number of fluoxetine (Prozac) prescriptions
increased, the number of suicides decreased.

However, the researchers add that their findings don't
preclude an increased suicide risk in small populations, and
recommend that the relationship between suicide and SSRI drug
treatment should be further examined.

SOURCE: American Journal of Psychiatry, May 2006.