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Impact of antidepressants on the risk of suicide in patients with depression in real-life conditions: a decision analysis model

  • A. Cougnard (a1), H. Verdoux (a1), A. Grolleau (a1), Y. Moride (a2), B. Begaud (a1) and M. Tournier (a1)...

Abstract

Background

The impact of antidepressant drug treatment (ADT) on the risk of suicide is uncertain. The aim of this study was to determine in a real-life setting whether ADT is associated with an increased or a reduced risk of suicide compared to absence of ADT (no-ADT) in patients with depression.

Method

A decision analysis method was used to estimate the number of suicides prevented or induced by ADT in children and adolescents (10–19 years old), adults (20–64 years old) and the elderly (⩾65 years) diagnosed with major depression. The impact of gender and parasuicide history on the findings was explored within each age group. Sensitivity analyses were used to assess the robustness of the models.

Results

Prescribing ADT to all patients diagnosed with depression would prevent more than one out of three suicide deaths compared to the no-ADT strategy, irrespective of age, gender or parasuicide history. Sensitivity analyses showed that persistence in taking ADT would be the main characteristic influencing the effectiveness of ADT on suicide risk.

Conclusions

Public health decisions that contribute directly or indirectly to reducing the number of patients with depression who are effectively administered ADT may paradoxically induce a rise in the number of suicides.

Copyright

Corresponding author

*Address for correspondence: Professor H. Verdoux, Hôpital Charles Perrens, 121 rue de la Béchade, 33076 Bordeaux cedex, France. (Email: helene.verdoux@u-bordeaux2.fr)

References

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Abenhaim, L (2003). Analysis of available knowledge on selected health problems, their determinants and the public health strategies: report of the National Technical Group of Definition of public health objectives in collaboration with the French Institute of Health and Medical Research (INSERM). General Health Directorate. France (http://www.sante.gouv.fr/htm/dossiers/losp/rapport_integral.pdf). Accessed 15 September 2006.
Anderson, MI, Nutt, DJ, Deakin, JF (2000). Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. Journal of Psychopharmacology 14, 320.
Angst, J, Angst, F, Gerber-Werder, R, Gamma, A (2005). Suicide in 406 mood-disorder patients with and without long-term medication: a 40 to 44 years' follow-up. Archives of Suicide Research 9, 279300.
Avery, D, Winokur, G (1976). Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Archives of General Psychiatry 33, 10291037.
Baldessarini, RJ, Tondo, L, Strombom, IM, Dominguez, S, Fawcett, J, Licinio, J, Oquendo, MA, Tollefson, GD, Valuck, RJ, Tohen, M (2007). Ecological studies of antidepressant treatment and suicidal risks. Harvard Review of Psychiatry 15, 133145.
Bijl, RV, Ravelli, A, van Zessen, G (1998). Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology 33, 587595.
CDC (2005). Web-based Injury Statistics Query and Reporting System (WISQARS) Injury Mortality Reports, 1999–2005. 2005, United States Suicide Injury Deaths and Rates per 100 000. U.S. Centers for Disease Control and Prevention (http://webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html). Accessed 2 September 2008.
Chen, YW, Dilsaver, SC (1996). Lifetime rates of suicide attempts among subjects with bipolar and unipolar disorders relative to subjects with other Axis I disorders. Biological Psychiatry 39, 896899.
Collet, JP, Boivin, JF (2000). Bias and confounding. In Pharmacoepidemiology, 3rd edn (ed. Strom, B. L.), pp. 765784. Wiley: Chichester.
Conwell, Y, Duberstein, PR, Caine, ED (2002). Risk factors for suicide in later life. Biological Psychiatry 52, 193204.
Cougnard, A, Salmi, LR, Salamon, R, Verdoux, H (2005). A decision analysis model to assess the feasibility of the early detection of psychosis in the general population. Schizophrenia Research 74, 2736.
Detsky, AS, Naglie, G, Krahn, MD, Naimark, D, Redelmeier, DA (1997). Primer on medical decision analysis: Part 1. Getting started. Medical Decision Making 17, 123125.
FDA (2006). Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). Department of Health and Human Services PHS, U.S. Food and Drug Administration, Center for Drug Evaluation and Research (www.fda.gov/OHRMS/DOCKETS/AC/06/briefing/2006-4272b1-01.FDA.pdf). Accessed 2 September 2008.
Gunnell, D, Ashby, D (2004). Antidepressants and suicide: what is the balance of benefit and harm. British Medical Journal 329, 3438.
Gunnell, D, Saperia, J, Ashby, D (2005). Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. British Medical Journal 330, 385388.
Hall, WD (2006). How have the SSRI antidepressants affected suicide risk? Lancet 367, 19591962.
Harris, EC, Barraclough, B (1997). Suicide as an outcome for mental disorders. A meta-analysis. British Journal of Psychiatry 170, 205228.
Harris, EC, Barraclough, B (1998). Excess mortality of mental disorder. British Journal of Psychiatry 173, 1153.
Jick, H, Kaye, JA, Jick, SS (2004). Antidepressants and the risk of suicidal behaviors. Journal of the American Medical Association 292, 338343.
Klein, DF (2006). The flawed basis for FDA post-marketing safety decisions: the example of anti-depressants and children. Neuropsychopharmacology 31, 689699.
Lecadet, J, Vidal, P, Baris, B, Vallier, N, Fender, P, Allemand, H (2000). Psychotropic Medications: Prescriptions and Use in Metropolitan France. I. National Data for 2000 (http://www.ameli.fr/fileadmin/user_upload/documents/Psychotropes_donnees_nat.pdf). Accessed 15 September 2006.
Lenzer, J (2004). FDA panel urges ‘black box’ warning for antidepressants. British Medical Journal 329, 702.
Li, XY, Phillips, MR, Zhang, YP, Xu, D, Yang, GH (2008). Risk factors for suicide in China's youth: a case-control study. Psychological Medicine 38, 397406.
Mattisson, C, Bogren, M, Horstmann, V, Munk-Jorgensen, P, Nettelbladt, P (2007). The long-term course of depressive disorders in the Lundby Study. Psychological Medicine 37, 883891.
Mitchell, J, McCauley, E, Burke, PM, Moss, SJ (1988). Phenomenology of depression in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 27, 1220.
Mulder, RT, Joyce, PR, Frampton, CM, Luty, SE (2008). Antidepressant treatment is associated with a reduction in suicidal ideation and suicide attempts. Acta Psychiatrica Scandinavica 118, 116122.
Naglie, G, Krahn, MD, Naimark, D, Redelmeier, DA, Detsky, AS (1997). Primer on medical decision analysis: Part 3. Estimating probabilities and utilities. Medical Decision Making 17, 136141.
Oh, PI, Iskedjian, M, Addis, A, Lanctot, K, Einarson, TR (2001). Pharmacoeconomic evaluation of clozapine in treatment-resistant schizophrenia: a cost-utility analysis. Canadian Journal of Clinical Pharmacology 8, 199206.
Olfson, M, Marcus, SC, Shaffer, D (2006). Antidepressant drug therapy and suicide in severely depressed children and adults: a case-control study. Archives of General Psychiatry 63, 865872.
Palmer, CS, Brunner, E, Ruiz-Flores, LG, Paez-Argraz, F, Revicki, DA (2002). A cost-effectiveness clinical decision analysis model for treatment of schizophrenia. Archives of Medical Research 33, 572580.
Rahme, E, Dasgupta, K, Turecki, G, Nedjar, H, Galbaud du Fort, G (2008). Risks of suicide and poisoning among elderly patients prescribed selective serotonin reuptake inhibitors: a retrospective cohort study. Journal of Clinical Psychiatry 69, 349357.
Rihmer, Z, Akiskal, H (2006). Do antidepressants t(h)reat(en) depressives? Toward a clinically judicious formulation of the antidepressant-suicidality FDA advisory in light of declining national suicide statistics from many countries. Journal of Affective Disorders 94, 313.
Ritchie, K, Artero, S, Beluche, I, Ancelin, ML, Mann, A, dupuy, AM, Malafosse, A, Boulenger, JP (2004). Prevalence of DSM-IV psychiatric disorder in the French elderly population. British Journal of Psychiatry 184, 147152.
Sondergard, L, Lopez, AG, Andersen, PK, Kessing, LV (2007). Continued antidepressant treatment and suicide in patients with depressive disorder. Archives of Suicide Research 11, 163175.
Tiihonen, J, Lonnqvist, J, Wahlbeck, K, Klaukka, T, Tanskanen, A, Haukka, J (2006). Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort. Archives of General Psychiatry 63, 13581367.
Tournier, M, Moride, Y, Greenfield, B, Galbaud du Fort, G, Ducruet, T (2007). Non-persistence with antidepressant therapy in the Quebec youth. In 16th AEP European Congress of Psychiatry, 5–9 April, 2008, Nice, France. European Psychiatry 23, S208–S209.
TreeAge Pro (2005). TreeAge Pro, version 2005, release 1.0, TreeAge Software, Inc., Williamstown, MA. (http://www.treeage.com/).
Vos, T, Haby, MM, Barendregt, JJ, Kruijshaar, M, Corry, J, Andrews, G (2004). The burden of major depression avoidable by longer-term treatment strategies. Archives of General Psychiatry 61, 10971103.
WHO (1992). The ICD-10 Classification of Mental and Behaviour Disorders: Clinical Descriptions and Diagnostic Guidelines. World Health Organization: Geneva.
WHO (2002). Gender and Mental Health. World Health Organization: Geneva.
Zimmerman, M, Chelminski, I, Posternak, MA (2005). Generalizability of antidepressant efficacy trials: differences between depressed psychiatric outpatients who would or would not qualify for an efficacy trial. American Journal of Psychiatry 162, 13701372.

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