ANTIDEPRESSANTS AND SUICIDE

Objective-To estimate the rate and means of suicide among people takin g 10 commonly prescribed antidepressant drugs: dothiepin, amitriptylin e, clomipramine, imipramine, flupenthixol, lofepramine, mianserin, flu oxetine, doxepin, and trazodone. Design-Open cohort study with a neste d case-control analysis. Setting-General practices in the United Kingd om that used VAMP computers to maintain their patient records from Jan uary 1988 to February 1993. Subjects-172 598 people who had at least o ne prescription for one of the 10 antidepresssants during the study pe riod. Main outcome measure-Suicide confirmed by general practitioner o r on death certificate, or both. Results-143 people committed suicide. The overall rate of suicide was estimated to be 8.5 per 10 000 person years (95% confidence interval 7.2 to 10.0). Rates of suicide were hi gher in men than women (relative risk 2.8 (95% confidence interval 1.9 to 4.0)), people with a history of feeling suicidal (19.2 (9.5 to 38. 7)), and people who had taken several different antidepressants (2.8 ( 1.8 to 4.3)). People who received high doses of antidepressants and th ose who had had a prescription in the 30 days before they committed su icide were also at higher risk than those who had received low doses a nd had had their prescriptions 30 or more days previously (2.3 (1.4 to 3.7) and 2.3 (1.6 to 3.4)) respectively. Rates of suicide were higher in patients who received fluoxetine, but this may be explained by sel ection biases which were present for those drug users. Conclusion-Seve ral factors correlate with the risk of suicide in people taking antide pressants. After controlling for these factors, the risk of suicide wa s similar among the 10 study antidepressants. Overdose with antidepres sants accounted for only 14% of the suicides.