Risks of Suicide and Poisoning Among Elderly Patients Prescribed Selective Serotonin Reuptake Inhibitors: A Retrospective Cohort Study
J Clin Psychiatry 2008;69(3):349-357
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Treatment with selective serotonin reuptake
inhibitors (SSRIs) has been associated with increased suicide risk. Risks of
suicide death and of poisoning were compared during periods of SSRI treatment
versus periods without any antidepressant treatment among elderly patients.
Method: In this retrospective cohort study, records from the
Quebec Health Care Fund and Vital Statistics databases were obtained for
patients 65 years and older who had filled a prescription for an SSRI between
January 1998 and December 2004. Patients were followed from the filling date of
the first SSRI prescription during the study period until death, the end of the
first period extending for at least 365 days with no antidepressant supply, or
December 31, 2004, whichever occurred first.
Results: The cohort included 128,229 patients (mean age = 75.4
years), 70% of whom were women. Numbers of suicide deaths (crude rate/100,000
patient-years) were 37 (23) during SSRI use, 16 (51) during other
antidepressant use, 5 (54) during use of both an SSRI and another
antidepressant, and 29 (29) during no antidepressant use. The adjusted risk of
suicide death (Cox regression model with time-dependent exposure) was not
higher during SSRI use versus nonuse (hazard ratio [95% CI]): any SSRI = 0.64
(0.38 to 1.07), paroxetine = 0.71 (0.37 to 1.35), citalopram = 1.16 (0.59 to
2.25), and sertraline = 0.38 (0.16 to 0.93). The adjusted hazard ratio (95% CI)
of poisoning was higher during SSRI use versus nonuse (1.16 [1.07 to 1.25]) and
varied between SSRI agents from 0.93 (0.74 to 1.16) for fluoxetine to 1.45
(1.23 to 1.71) for fluvoxamine.
Conclusion: Among elderly patients dispensed SSRIs, the risk
of suicide death was not higher during periods of SSRI use compared to when
antidepressants were not being used.