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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Suicide risk and antidepressants

The British Medical Journal has made a paper available through the Online First section of the website that examines the risk of suicide associated with several common antidepressants.

The study was a retrospective cohort study of the UK General Practice Research Database and examined suicide rates and attempted suicides associated with venlafaxine, citalopram, fluoxetine and dothiepin.

The study found higher rates of suicide in patients taking venlafaxine, however these patients were at higher risk of suicide at baseline and after accounting for confounders the differences observed should not be considered as causal.

The observe suicide rates were as follows:

  • venlafaxine - 0.64 per 1,000 person years
  • citalopram - 0.26 per 1,000 person years
  • fluoxetine - 0.23 per 1,000 person years
  • dothiepin - 0.27 per 1,000 person years

Background suicide rates are (calculated from National Office of Statistics data):

  • men - 0.181 per 1,000 person years
  • women - 0.063 per 1,000 person years

The risk of suicide is higher than baseline in patients treated common antidepressants. It remains unclear if this is a factor of depressive disease alone or if there is contribution from antidepressant therapy.

Action: Clinicians should assess suicide risk in all patients who exhibit symptoms of depression before commencing treatment.

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