Posted by Phillipa on May 5, 2010, at 20:59:43
In reply to Re: Lou's reply-rolthedyce » Lou Pilder, posted by SLS on May 5, 2010, at 12:43:24
Scott this the article? Phillipa
From Medscape Medical News
Antidepressant Use Carries Similar Suicidal Risks Across Drug Type, Class
Study in Adults Mirrors Recent Findings in Adolescents
Megan Brooks
May 4, 2010 In adults initiating antidepressant therapy, there appears to be no clinically relevant variation in risk for suicidal acts by individual type or class of antidepressant medication, according to a report in the May issue of Archives of General Psychiatry.
The finding, from Sebastian Schneeweiss, MD, ScD, of Harvard Medical School in Boston, Massachusetts, and colleagues, mirrors findings from a study in children and adolescents published this month in Pediatrics by the same researchers.
In October 2004, the US Food and Drug Administration issued an advisory regarding a potentially increased risk for suicidal thoughts and behaviors among children and adolescents taking antidepressants. A subsequent meta-analysis of trials in adults found no overall increase in risk, but data on individual agents were lacking.
Therefore, Dr. Schneeweiss and colleagues analyzed healthcare utilization data from all 287,543 British Columbia residents 18 years and older who started taking an antidepressant between January 1, 1997, and December 31, 2005.
The selective serotonin reuptake inhibitors (SSRIs) were the most common class of medication prescribed, accounting for 65.5% of antidepressant use. Paroxetine and citalopram, the most commonly prescribed agent, accounted for 39.7% and 24.2% of overall SSRI use, respectively.
During the first 12 months of treatment, the researchers identified 751 attempted and 104 completed suicides an event rate of 6.06 suicidal acts per 1000 person-years (95% confidence interval [CI], 5.65 6.48). Most of the events occurred in the first 6 months after initiation.
After extensive propensity score adjustment, the researchers failed to see any significant differences in the risk for suicide and suicide attempt among individual antidepressants or classes of antidepressants SSRIs, serotonin-norepinephrine reuptake inhibitors, tricyclic agents, or other newer and atypical agents.
Compared with the initiation of fluoxetine hydrochloride treatment, initiation of citalopram hydrobromide treatment yielded a hazard ratio (HR) of 1.00 (95% CI, 0.63 1.57), fluvoxamine maleate (HR, 0.98; 95% CI, 0.63 1.51), paroxetine hydrochloride (HR, 1.02; 95% CI, 0.77 1.35), and sertraline hydrochloride (HR, 0.75; 95% CI, 0.53 1.05).
Similar findings emerged in analyses restricted to a treatment-naive subgroup of patients with no antidepressant use in the prior 3 years (n = 199,594; 69.4%).
A major strength of the study, Dr. Schneeweiss and colleagues note, is its large and stable population, which allowed them to look at a variety of medications and at subgroups. However, the inability to fully adjust for mental health conditions is 1 limitation of the study.
"Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration's decision to treat all antidepressants alike in their advisory," Dr. Schneeweiss and colleagues conclude in their report.
"Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent," they add.
The study authors have disclosed no relevant financial relationships.
Arch Gen Psychiatry. 2010;67:497-506.
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