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Study Probes Suicide, Antidepressants

Antidepressants Up Suicide Attempts -- But Cut Actual Suicides

Suicide Due to Depression, Not Antidepressants

Tiihonen and colleagues took advantage of the extraordinarily detailed medical records kept on every person living in Finland.

The researchers combed through data on more than 15,000 people hospitalized for depression, but without psychosis, from 1997 through 2003.

The findings showed those who had at some point been treated with an antidepressant had a 39% higher risk of attempting suicide.

However, these same people had a 32% lower chance of dying of suicide.

Depression expert Julio Licinio, MD, chairman of the psychiatry department at the University of Miami, says this is an important finding.

"This very clearly makes a distinction between suicidal ideas/behavior and actual suicide," Licinio says.

"Actual suicide is the important outcome," he says.

"The more depressed you are, the more you think about suicide. The more you treat depression, the less suicide you have. And that is what this study shows," says Licinio.

Gibbons points to the study's finding that patients not treated with antidepressants are at higher risk of dying from suicide than those taking antidepressants.

"The increased rate of suicide completion among untreated patients may be due to the fraction who are depressed and are not being treated for their depression," he says.

"This is the big concern about [the FDA's] black box warnings -- they increase the rate of untreated depression, and can ultimately increase the rate of completed suicide," Gibbons says.

 

Surprise Finding: Antidepressants Cut Death Rate

The Finnish study turned up an unexpected relationship. Taking antidepressants appears to lower a person's risk of death -- from all causes, not just suicide.

"We surprisingly observed that antidepressant use was associated with decreased risk of death overall," Tiihonen says. "This was even more substantial than the decreased risk of suicide."

Tiihonen suspects antidepressants may protect against heart disease and stroke, possibly by reducing the risk of blood clots.

The data also suggest Paxil may be less safe for children and teens age 10 to 19.

Depressed children and teens of this age using the drug had more than a fivefold increased risk of death. However, since the numbers are small, this finding cannot be considered definitive.

Still, Tiihonen urges caution.

"One message from our study is that [Paxil] should not be used in those under age 19," he says.

The Tiihonen study was funded by subsidies from the government of Finland. The results appear in the December issue of Archives of General Psychiatry.

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