Rebutting claims that antidepressants trigger suicidal behavior, a new study has shown that the instances of serious suicide attempts and death by suicide actually come down after treatment with antidepressants begins. The study, by Group Health Cooperative (GHC) researchers, also said that new antidepressants like Paxil and Zoloft were better than older ones where low suicidal behavior was concerned.
“Our findings show that, fortunately, suicide attempts and death by suicide are rare following the initiation of antidepressants. The period right after people start taking antidepressant medication is not a period of increased risk. In fact, risk after starting medication is lower than before,” said Greg Simon, lead author of the study.
Earlier in October 2004, the US Food and Drug Administration (FDA), taking note of studies that showed increased suicidal behavior among adolescents taking antidepressants, had directed pharmaceutical companies to add black box warning to the labels of such medications. This resulted in a fall in the number of antidepressant prescriptions being handed out to youngsters.
Under the GHC study, computerized medical and pharmacy records of over 65,000 patients who used antidepressants between 1992 and 2003 were studied. Death certificates and hospital discharge data were also scrutinized to determine suicides and suicide attempts. An analysis showed that in the month when antidepressant treatment commenced there was a 60 per cent drop in suicide attempts among adults. This fell further in the five months that followed. Only 31 adults, from among the 65, 103 on antidepressants, committed suicide in the six months after treatment began.
In adolescents, however, the rate of suicide attempts was higher. In the first six months since antidepressant treatment began, around 314 attempts were noted per 100,000 teenaged patients as against the 78 attempts per 100,000 adult patients. But among teenagers, the highest number of such attempts occurred a month before treatment began and like in case of adults, fell 60 per cent after the commencement of the treatment.
Psychiatrists, however, have reported agitation among some people after they start taking antidepressants. “There may be subgroups of people who become more agitated or suicidal after taking these drugs. But our study showed that on average, the risk of suicide actually goes down after people start taking the antidepressant,” Simon said.
Hailing the findings, Darrel Regier of the American Psychiatric Association urged the FDA to review its warning labels on antidepressants. “The take-home message from these studies is that we have treatment that is effective and that the risk from depression is far greater than the risk of treatment,” he said.
Another study, by University of Texas Southwestern Medical Center in Dallas researchers, found that around 30 per cent of patients on antidepressant citalopram, sold as Celexa, saw full remission after undergoing antidepressant treatment for 12 weeks. The study, which tracked the responses of 2,876 people suffering from depression and taking citalopram, found that an additional 15 per cent of the study subjects saw some improvement in their mental condition due to the medication. “The good news is we got a third of patients to remission,” said Dr Madhukar Trivedi, lead author of the study.
Meanwhile, Simon cautioned that the findings of his study should not lead to psychiatrists becoming lax about tracking their patients' mental condition. “Keeping a close watch on patients after they begin taking these drugs is a good idea, although not because these medicines are especially risky or dangerous. Patients need to be monitored to ensure they're getting the right medication in the amount that can help them feel better,” he said.
The findings of both the studies have been published in the
American Journal of Psychiatry.
