A Case-Control Study of Antidepressants and Attempted Suicide During Early Phase Treatment of Major Depressive Episodes
J Clin Psychiatry 2008;69(3):425-432
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objective: To estimate the relative risk of suicide
attempts in child and adult outpatients initiating antidepressants for major
depressive episodes compared to those not treated with antidepressants.
Method: A nested matched case-control study was performed with
Medicaid administrative data (January 1, 1999-December 31, 2000) of outpatients
treated for a major depressive episode. Beneficiaries initiating treatment for
a major depressive episode were selected, excluding those who had recently
received inpatient psychiatric treatment or outpatient treatment of pregnancy,
major depressive episodes, bipolar disorder, schizophrenia or other psychoses,
mental retardation, dementia, or delirium or recent treatment with a mood
stabilizer, antidepressant, or antipsychotic. The outcome was treatment for a
suicide attempt during the first 120 days after starting treatment for a major
depressive episode. Controls were matched to cases on age, sex, race/ethnicity,
recent treatment of substance use disorder, severity and type of major
depressive episode, and other factors. Separate analyses were performed for
adults (aged 19 to 64 years) and children (aged 6 to 18 years).
Results: Among children, antidepressant treatment was
associated with a significant increase in suicide attempts (odds ratio [OR] =
2.08, 95% confidence interval [CI] = 1.06 to 4.10; cases, N = 51; controls, N =
239; p = .03). Among adults, antidepressant treatment was not significantly
related to risk of suicide attempts (OR = 0.85, 95% CI = 0.57 to 1.28; cases, N
= 185; controls, N = 893; p = .44), although among adult males, antidepressants
were associated with a significant protective effect (OR = 0.32, 95% CI = 0.12
to 0.83; cases, N = 57; controls, N = 268; p = .01).
Conclusions: In these outpatients initiating treatment for a
major depressive episode, antidepressant treatment appears to be associated
with an increased risk of treated suicide attempts in children and a decreased
risk in adult males.