February 12, 2014
Antidepressant Selection Does Not Change Suicide Risk in
Children, Teens

Nashville, TN—Amid fears that treating children and adolescents for depression with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) therapy can lead to suicidal behavior, research has raised the possibility that some formulations up the risk more than others.

In response to that concern, a new study compared the risk for medically treated suicide attempts among new users of sertraline, paroxetine, citalopram, escitalopram, and venlafaxine to risk for new users of fluoxetine. The population-based study of children recently initiating an antidepressant, led by Vanderbilt University researchers, found no evidence that the risk of suicide attempts differed between the commonly prescribed SSRI and SNRI antidepressants.

The retrospective cohort study included 36,842 children aged 6 to 18 years enrolled in Tennessee Medicaid between 1995 and 2006 who were new users of one of the antidepressant medications being studied. Medically treated suicide attempts were identified from Medicaid files and vital records, then confirmed with medical record review.

During the study, 419 of the children had a medically treated suicide attempt with explicit or inferred attempt to die, including four who took their own lives.

The rate of confirmed suicide attempts for the study drugs ranged from 24.0 per 1000 person-years to 29.1 per 1000 person-years. The study noted that adjusted rate of suicide attempts did not differ significantly among current users of SSRI and SNRI antidepressants compared with current users of fluoxetine. Researchers found, however, that users of multiple antidepressants concomitantly had increased risk for suicide attempt.

“Previous analyses of clinical trials data suggested that there may be differences in the risk of suicidality among antidepressants, including particular evidence of increased risk for venlafaxine,” the authors write. “We found no evidence of increased risk for venlafaxine or any of the other drugs studied, although the point estimate for venlafaxine was higher than that for fluoxetine.”

The increased risk of suicidal behavior for study participants with overlapping use of multiple antidepressants “likely reflects the increased severity of depression for these individuals rather than a drug effect,” the researchers suggest.

For children on a single antidepressant studied, however, “Use of any of the individual drugs studied would not be expected to increase risk for serious suicide attempts compared with the others,” the authors conclude.

U.S. Pharmacist Social Connect