RISK OF SUICIDE ATTEMPTS AFTER BENZODIAZEPINE AND OR ANTIDEPRESSANT USE/

PURPOSE: Recent publications imply the existence of associations betwe en psychotropic drugs use and risk of suicide. Some studies have measu red the tissue level of these drugs in suicide deaths, while others co mpared toxicity indices, defined as number of suicide deaths per milli on prescriptions for individual antidepressants. Few of these studies used unexposed controls. The objective of this cohort study was to eva luate suicide attempts in subjects recently exposed to benzodiazepines and/or antidepressants, as compared to unexposed controls. METHODS: A population of 225,796 persons with prescriptions for benzodiazepines were selected from the Saskatchewan Health Data Bases. Controls consis ted of 97,862 individuals who did not receive benzodiazepines. RESULTS : Stratifying the populations into antidepressant users and non-antide pressant users indicated that nonantidepressant users had statisticall y significant associations between suicide attempts and benzodiazepine use (odds ratio (OR) = 6.2), antipsychotic use, (OR = 2.6), and a his tory of past treatment for drug/alcohol abuse (OR = 13.4). Antidepress ant users showed a statistically significant relation only with past t reatment for drug/alcohol use (OR = 5.8). It is argued that the large OR for antidepressant use is due to confounding by indication. If so, the concept of toxicity index is misleading and should not be used. CO NCLUSIONS: The association between benzodiazepine use and attempted su icide is especially high for nonantidepressant users, for the young, a nd for males. Whether this relationship is causal or not, physicians s hould be aware of the high potential for suicide attempts when prescri bing benzodiazepines for patients in these high risk groups. (C) 1997 Elsevier Science Inc.