Healthy Skepticism Library item: 6156

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Publication type: Journal Article

Olfson M, Marcus SC, Shaffer D.
Antidepressant drug therapy and suicide in severely depressed children and adults: A case-control study.
Arch Gen Psychiatry 2006 Aug 01; 63:(8):865-72
http://archpsyc.ama-assn.org/cgi/content/full/63/8/865

Abstract:

CONTEXT: The Food and Drug Administration has issued a boxed warning concerning increased suicidal ideation and behavior associated with antidepressant drug treatment in children and adolescents. It is unknown whether antidepressant agents increase the risk of suicide death in children or adults. OBJECTIVE: To estimate the relative risk of suicide attempt and suicide death in severely depressed children and adults treated with antidepressant drugs vs those not treated with antidepressant drugs. DESIGN: Matched case-control study. SETTING: Outpatient treatment settings in the United States. PARTICIPANTS: Medicaid beneficiaries from all 50 states who received inpatient treatment for depression, excluding patients treated for pregnancy, bipolar disorder, schizophrenia or other psychoses, mental retardation, dementia, or delirium. Controls were matched to cases for age, sex, race or ethnicity, state of residence, substance use disorder, recent suicide attempt, number of days since hospital discharge, and recent treatment with antipsychotic, anxiolytic/hypnotic, mood stabilizer, and stimulant medications. MAIN OUTCOME MEASURES: Suicide attempts and suicide deaths. RESULTS: In adults (aged 19-64 years), antidepressant drug treatment was not significantly associated with suicide attempts (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.86-1.39 [521 cases and 2394 controls]) or suicide deaths (OR, 0.90; 95% CI, 0.52-1.55 [86 cases and 396 controls]). However, in children and adolescents (aged 6-18 years), antidepressant drug treatment was significantly associated with suicide attempts (OR, 1.52; 95% CI, 1.12-2.07 [263 cases and 1241 controls]) and suicide deaths (OR, 15.62; 95% CI, 1.65-infinity [8 cases and 39 controls]). CONCLUSIONS: In these high-risk patients, antidepressant drug treatment does not seem to be related to suicide attempts and death in adults but might be related in children and adolescents. These findings support careful clinical monitoring during antidepressant drug treatment of severely depressed young people.

Keywords:
Adolescent Adult Age Distribution Age Factors Ambulatory Care Antidepressive Agents/adverse effects* Antidepressive Agents/therapeutic use* Case-Control Studies Cause of Death Child Depressive Disorder/drug therapy* Depressive Disorder/mortality Depressive Disorder/psychology* Drug Labeling/legislation & jurisprudence Humans Medical Assistance/statistics & numerical data Middle Aged Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Risk Factors Severity of Illness Index Suicide/psychology Suicide/statistics & numerical data* Suicide, Attempted/psychology Suicide, Attempted/statistics & numerical data United States United States Food and Drug Administration