Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults: A Case-Control Study | Adolescent Medicine | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 34.204.185.54. Please contact the publisher to request reinstatement.
1.
Brent  DA Antidepressants and pediatric depression: the risk of doing nothing.  N Engl J Med 2004;3511598- 1601PubMedGoogle ScholarCrossref
2.
Newman  TB A black-box warning for antidepressants in children?  N Engl J Med 2004;3511595- 1598PubMedGoogle ScholarCrossref
3.
Hammad  TALaughren  TRacoosin  J Suicidality in pediatric patients treated with antidepressant drugs.  Arch Gen Psychiatry 2006;63332- 339PubMedGoogle ScholarCrossref
4.
Cipriani  ABarbui  CGeddes  JR Suicide, depression and antidepressants: patients and clinicians need to balance benefits and harms.  BMJ 2005;330373- 374PubMedGoogle ScholarCrossref
5.
Fergusson  DDoucette  SGlass  KCShapiro  SHealy  DHebert  PHutton  B Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials.  BMJ 2005;330396- 399PubMedGoogle ScholarCrossref
6.
Gunnell  DSaperia  JAshby  D Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomized trials submitted to the MHRA's safety review.  BMJ 2005;330385- 388PubMedGoogle ScholarCrossref
7.
 Data for antidepressant use in adults. FDA Talk Paper. July 1, 2005.http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01362.htmlAccessed May 22, 2006
8.
Spicer  RSMiller  TR Suicide acts in 8 states: incidence and case fatality rates by demographics and method.  Am J Public Health 2000;901885- 1891PubMedGoogle ScholarCrossref
9.
Khan  AKhan  SKolts  RBrown  WA Suicide rates in clinical trials of SSRIs, antidepressants, and placebo: analysis of FDA reports.  Am J Psychiatry 2003;160790- 792PubMedGoogle ScholarCrossref
10.
Grunebaum  MFEllis  SPLi  SOquendo  MAMann  JJ Antidepressants and suicide risk in the United States, 1985-1999.  J Clin Psychiatry 2004;651456- 1462PubMedGoogle ScholarCrossref
11.
Gibbons  RDHur  KBhaumik  DKMann  JJ The relationship between antidepressant medication use and rate of suicide.  Arch Gen Psychiatry 2005;62165- 172PubMedGoogle ScholarCrossref
12.
Isacsson  G Suicide prevention: a medical breakthrough?  Acta Psychiatr Scand 2000;102113- 117PubMedGoogle ScholarCrossref
13.
Olfson  MShaffer  DMarcus  SCGreenberg  T Relationship of antidepressant medication use to suicide in adolescents.  Arch Gen Psychiatry 2003;60978- 982PubMedGoogle ScholarCrossref
14.
Carlsten  AWaern  MEkedahl  ARanstam  J Antidepressant medication and suicide in Sweden.  Pharmacoepidemiol Drug Saf 2001;10525- 530PubMedGoogle ScholarCrossref
15.
Conwell  YDuberstein  PRCox  CHermann  JHForbes  NTCaine  ED Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy.  Am J Psychiatry 1996;1531001- 1008PubMedGoogle Scholar
16.
Foster  TGillespie  KMcClelland  R Mental disorders and suicide in Northern Ireland.  Br J Psychiatry 1997;170447- 452PubMedGoogle ScholarCrossref
17.
Brent  DAPerper  JAMoritz  GAllman  CFriend  ARoth  CSchweers  JBalach  LBaugher  M Psychiatric risk factors for adolescent suicide: a case-control study.  J Am Acad Child Adolesc Psychiatry 1993;32521- 529PubMedGoogle ScholarCrossref
18.
Shaffer  DGould  MSFisher  PTrautman  PMoreau  DKleinman  MFlory  M Psychiatric diagnosis in child and adolescent suicide.  Arch Gen Psychiatry 1996;53339- 348PubMedGoogle ScholarCrossref
19.
Geddes  JRCarney  SMDavies  CFurukawa  TAKupfer  DJFrank  EGoodwin  GM Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review.  Lancet 2003;361653- 661PubMedGoogle ScholarCrossref
20.
March  JSilva  SPetrycki  SCurry  JWells  KFairbank  JBurns  BDomino  MMcNulty  SVitiello  BSevere  JTreatment for Adolescents With Depression Study (TADS) Team, Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.  JAMA 2004;292807- 820PubMedGoogle ScholarCrossref
21.
Henriksson  SBoethius Isacsson  G Suicides are seldom prescribed antidepressants: findings from a prospective prescription database in Jamtland County, Sweden 1985-1995.  Acta Psychiatr Scand 2001;103301- 306PubMedGoogle ScholarCrossref
22.
Rich  CLIsacsson  G Suicide and antidepressants in south Alabama: evidence for improved treatment of depression.  J Affect Disord 1997;45135- 142PubMedGoogle ScholarCrossref
23.
Isacsson  GHolmgren  PAhlner  J Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides.  Acta Psychiatr Scand 2005;111286- 290PubMedGoogle ScholarCrossref
24.
Jick  HKaye  JAJick  SA Antidepressants and the risk of suicidal behavior.  JAMA 2004;292338- 343PubMedGoogle ScholarCrossref
25.
Jick  SSDean  ADJick  H Antidepressants and suicide.  BMJ 1995;310215- 218PubMedGoogle ScholarCrossref
26.
Martinez  CRietbrock  SWise  LAshby  DChick  JMoseley  JEvans  SGunnell  D Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study.  BMJ 2005;330389- 393PubMedGoogle ScholarCrossref
27.
Lurie  NPopkin  MDysken  MMoscovice  IFinch  M Accuracy of diagnoses of schizophrenia in Medicaid claims.  Hosp Community Psychiatry 1992;4369- 71PubMedGoogle Scholar
28.
Marcus  SMFlynn  HABlow  FBarry  K A screening study of antidepressant treatment rates and mood symptoms in pregnancy.  Arch Womens Ment Health 2005;825- 27PubMedGoogle ScholarCrossref
29.
Gentile  S The safety of newer antidepressants in pregnancy and breastfeeding.  Drug Saf 2005;28137- 152PubMedGoogle ScholarCrossref
30.
Boerlin  HLGitlin  MJZoellner  LAHammen  CL Bipolar depression and antidepressant-induced mania: a naturalistic study.  J Clin Psychiatry 1998;59374- 389PubMedGoogle ScholarCrossref
31.
Whitehead  CMoss  SCardno  ALewis  G Antidepressants for the treatment of depression in people with schizophrenia: a systematic review.  Psychol Med 2003;33589- 599PubMedGoogle ScholarCrossref
32.
McBrien  JA Assessment and diagnosis of depression in people with intellectual disability.  J Intellect Disabil Res 2003;471- 13PubMedGoogle ScholarCrossref
33.
Snow  ALKunik  MEMolinari  VAOrengo  CADoody  RGraham  DPNorris  MP Accuracy of self-reported depression in persons with dementia.  J Am Geriatr Soc 2005;53389- 396PubMedGoogle ScholarCrossref
34.
 National Death Index User's Manual.  Hyattsville, Md Centers for Disease Control and Prevention, National Center for Health Statistics January2003;
35.
Preskorn  SH Comparison of the tolerability of bupropion, fluoxetine, imipramine, nefazodone, paroxetine, sertraline, and venlafaxine.  J Clin Psychiatry 1995;5612- 21PubMedGoogle Scholar
36.
Haddad  PM Antidepressant discontinuation syndromes.  Drug Saf 2001;24183- 197PubMedGoogle ScholarCrossref
37.
Potter  DM A permutation test for inference in logistic regression with small- and moderate-sized data sets.  Stat Med 2005;24693- 708PubMedGoogle ScholarCrossref
38.
Qin  PNordentoft  M Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers.  Arch Gen Psychiatry 2005;62427- 432PubMedGoogle ScholarCrossref
39.
Osby  UBrndt  LCorreia  NEkbom  ASparen  P Excess mortality in bipolar and unipolar disorder in Sweden.  Arch Gen Psychiatry 2001;58844- 850PubMedGoogle ScholarCrossref
40.
Palmer  BAPankratz  VSBostwick  JM The lifetime risk of suicide in schizophrenia: a re-examination.  Arch Gen Psychiatry 2005;62247- 253PubMedGoogle ScholarCrossref
41.
Inskip  HMHarris  ECBarraclough  B Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia.  Br J Psychiatry 1998;17235- 37PubMedGoogle ScholarCrossref
42.
Cooper  JKapur  NWebb  RLawlor  MGuthrie  EMackway-Jones  KAppleby  L Suicide after deliberate self-harm: a 4-year cohort study.  Am J Psychiatry 2005;162297- 303PubMedGoogle ScholarCrossref
43.
Goldston  DBDaniel  SSReboussin  DMReboussin  BAFrazier  PHKelley  AE Suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study of risk during the first 5 years after discharge.  J Am Acad Child Adolesc Psychiatry 1999;38660- 671PubMedGoogle ScholarCrossref
44.
Velting  DMGould  MS Suicide contagion. In:MarisCanetto  SSilverman  MMeds. Annual Review of Suicidology.  New York, NY Guilford1997;96- 136
45.
Gould  MSFisher  PParides  MFlory  MShaffer  D Psychosocial risk factors of child and adolescent completed suicide.  Arch Gen Psychiatry 1996;531155- 1162PubMedGoogle ScholarCrossref
46.
Webster  DWVernick  JSZeoli  AMManganello  JA Association between youth-focused firearm laws and youth suicide.  JAMA 2004;292594- 601PubMedGoogle ScholarCrossref
47.
Kwon  ABungay  KMPei  URogers  WHWilson  IBZhou  QAdler  DA Antidepressant use: concordance between self-report and claims records.  Med Care 2003;41368- 374PubMedGoogle Scholar
48.
McKenzie  DASemradek  JMcFarland  BHMullooly  JPMcCamant  LE The validity of Medicaid pharmacy claims for estimating drug use among elderly nursing home residents: the Oregon experience.  J Clin Epidemiol 2000;531248- 1257PubMedGoogle ScholarCrossref
49.
Mohler  BEarls  F Trends in adolescent suicide: misclassification bias?  Am J Public Health 2001;91150- 153PubMedGoogle ScholarCrossref
50.
Stanistreet  DTaylor  SJeffrey  VGabbay  M Accident or suicide? predictors of coroners' decisions in suicide and accident verdicts.  Med Sci Law 2001;41111- 115PubMedGoogle Scholar
51.
Melfi  CACroghan  TWHanna  MP Access to treatment for depression in a Medicaid population.  J Health Care Poor Underserved 1999;10201- 215PubMedGoogle ScholarCrossref
Original Article
August 2006

Antidepressant Drug Therapy and Suicide in Severely Depressed Children and Adults: A Case-Control Study

Author Affiliations

Author Affiliations: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York (Drs Olfson and Shaffer); and University of Pennsylvania School of Social Policy and Practice, Philadelphia (Dr Marcus).

Arch Gen Psychiatry. 2006;63(8):865-872. doi:10.1001/archpsyc.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.

×