Suicide trends in discharged patients with mood disorders: associations with selective serotonin uptake inhibitors and comorbid substance misuse.
Fazel S, Grann M and Goodwin GM;
Commented by , 22 Mar 2006
Background
Aggregate data from randomized controlled studies in children and adolescents and a recent meta-analysis of data from such trials in adults found increased rates of self-harm in individuals prescribed SSRIs (ref. 1; ref. 2). However, the data for completed suicides in these controlled studies cannot be conclusive, limited, as they inevitably are, by small numbers and low event rates.
Method
Two Swedish populations were identified: the whole general population and a population of inpatients discharged with a diagnosis of non-psychotic depression or other non-psychotic mood disorders or with a diagnosis of an anxiety disorder. Rates of suicide during a period without SSRIs (1989–94) were compared with rates during a period with increasing use of SSRIs (1995–2000) for the two populations, respectively.
Results
There were a total of 20,851 suicides in the general population during 1989–2000, and 1606 in inpatients discharged with mood disorders. When 1995–2000 was compared with 1989–94 there were statistically significant decreases in general population suicides in both men and women across three age bands.
In the inpatient group, suicide rates decreased significantly in women in 1995–2000 compared to 1989–94; the suicide rates in men discharged from hospital also fell, but the effect appeared to be smaller and did not reach statistical significance. No change in rates of comorbid substance misuse was seen in those inpatients who committed suicide.
Professor Kessing's comments
These findings are not compatible with the view that widespread prescribing of SSRIs has caused suicide. However, as indicated by the authors, suicide rates have been decreasing in Sweden since the 1970s, and therefore the population level data presented in the study cannot be interpreted simply as a protective effect of SSRIs on suicide rates.
Thus, data were not available on individual patients use of SSRIs. The findings could in stead reflect other secular changes that were not measured or anticipated. Nevertheless, the study does not support a reluctant attitude in prescription of SSRIs based on a fear of suicide for patients with mood or anxiety disorders.
On the contrary, it is well known that untreated depressive disorders are associated with a severely increased suicide rate.
References
1. Whittington CJ, Kendall T, Fonagy PP, Cottrell PD, Cotgrove A and Boddington E. Selective serotonin reuptake inhibitors in childhood depression: systematic review of published cersus data . Lancet 2004; 363 (9418); 1341–1345
2. Gunnell D and Ashby D. Antidepressants and suicide: what is the balance of benefit and harm. BMJ 2004; 329 (7456); 34–38 (Free full text article)