Suicidal Risk During Antidepressant Treatment
To the Editor: The recent report by Stübner and colleagues1 of a large clinical survey of over 142,000 European patients treated with various antidepressants from 1993-2008 concluded that antidepressant treatment may, rarely, increase risks of suicidal behavior. The rate of suicide was 3/142,090 in an unspecified exposure time, or 2.1/100,000, and for suicide attempts, 18/142,090, or 12.7/100,000.
The risk-ratio of 6.0 attempts/suicide in patients treated with antidepressants (presumably diagnosed with depressive or anxiety disorders) accords with comparable findings among patients with DSM-IV major depression under various conditions of treatment.2 However, the observed suicide rate (2.1/100,000) is far lower than expected in clinical samples (approximately 50/100,000/year among patients with major depressive disorder2) and lower even than the annual suicide rate in the international general population (approximately 15/100,0003). Despite the limited number of suicide-related adverse events and associated lack of statistical power, these considerations may suggest that antidepressant treatment was associated with a lower risk of suicides and attempts, particularly if the rates remain much lower than expected when adjusted for exposure time.
Finally, the rates of identified suicidal ideation (12/142,090 = 8.4/100,000) were lower than the rate for suicide attempts (12.7/100,000). This result suggests that suicidal ideation may not be reliably ascertained in such studies of reported adverse events, again indicating that the nonspecific term suicidality may sometimes be misleading.4
References
1. Stübner S, Grohmann R, von Stralendorff I, et al. Suicidality a rare adverse event of antidepressant medication: report from the AMSP multicenter drug safety surveillance project. J Clin Psychiatry. 2010;71(10):1293-1307. PubMed doi:10.4088/JCP.09m05912blu
2. Tondo L, Lepri B, Baldessarini RJ. Suicidal risks among 2826 Sardinian major affective disorder patients. Acta Psychiatr Scand. 2007;116(6):419-428. PubMed doi:10.1111/j.1600-0447.2007.01066.x
3. Baldessarini RJ, Tondo L. Psychopharmacology for suicide prevention. In: Pompili M, Tatarelli R, eds. Evidence-Based Practice in Suicidology: A Sourcebook. Gottingen, Germany: Hogrefe Publishing, GmbH; 2010:243-264.
4. Meyer RE, Salzman C, Youngstrom EA, et al. Suicidality and risk of suicide—definition, drug safety concerns, and a necessary target for drug development: a brief report. J Clin Psychiatry. 2010;71(8):1040-1046. PubMed doi:10.4088/JCP.10cs06070ablu
Author affiliation: Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. Potential conflicts of interest: The author and his family have no current financial relationships with pharmaceutical or biomedical corporations. Funding/support: Supported, in part, by a grant from the Bruce J. Anderson Foundation and by the McLean Private Donors Psychopharmacology Research Fund.
doi:10.4088/JCP.10lr06729
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