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Study Probes Suicide, Antidepressants

Antidepressants Up Suicide Attempts -- But Cut Actual Suicides

Medically Reviewed by Louise Chang, MD on December 04, 2006
From the WebMD Archives

Dec. 4, 2006 -- Antidepressant treatment ups a person's risk of suicide attempts -- but cuts the risk of actual suicide, data from Finland reveal.

Also, in a surprising finding, the same study suggests a link between antidepressant use and reduced risk of death overall.

The reason for this apparent benefit is unclear and will require further study, the researchers report.

The Finnish study comes in the midst of continuing controversy over the benefits vs. risks of antidepressants.

Clinical trials of antidepressants find that people who begin treatment seem to have a higher risk of suicidal thoughts and gestures.

That is why the drugs' labels carry a strong warning that they may up a depressed person's risk of suicide.

But the new findings suggest the real culprit is depression, not antidepressant drugs, says Jari Tiihonen, MD, PhD, chairman of the department of forensic psychiatry at the University of Kuopio, Finland.

"We found out the use of antidepressant treatment was associated with increased risk of attempted suicide," Tiihonen tells WebMD.

"But treatment was also associated with decreases in completed suicide," he says.

When people on antidepressants attempt suicide, Tiihonen says, they most often try to kill themselves by taking too many antidepressant pills.

"When patients have antidepressant medications at home, it is easy for them to open the bottle and make a suicide attempt," he says. "Nowadays, these drugs are not so toxic, so it is hard to kill oneself with these medicines."

However, they rarely attempt suicide by more fatal means. "Suicide attempts by hanging and shooting are not increased among patients taking antidepressants," Tiihonen says.

This makes a lot of sense to Robert D. Gibbons, PhD, director of the Center for Health Statistics and professor of psychiatry at the University of Illinois at Chicago.

"If you are taking an antidepressant, it is pretty good evidence that you are depressed," Gibbons says. "Giving depressed patients bottles of pills that can be used to attempt suicide could increase the suicide attempt rate."

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.

WebMD Health News

Sources

SOURCES: Tiihonen, J. Archives of General Psychiatry, December 2006; vol 63: pp 1353-1367. Jari Tiihonen, MD, PhD, professor and chairman, department of forensic psychiatry, University of Kuopio, Niuvanniemi Hospital, Finland. Julio Licinio, MD, professor and chairman, department of psychiatry & behavioral sciences, University of Miami. Robert D. Gibbons, PhD, director, Center for Health Statistics and professor of psychiatry, University of Illinois at Chicago.

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