Antidepressant Use and Suicide: Reassuring Findings

Two studies in the American Journal of Psychiatry offer some reassurance about antidepressant therapy and suicide risk.
The first, done in a large prepaid health plan, examined insurance claims for antidepressants or psychotherapy for new episodes of depression. Claims were also examined for evidence of suicide attempts in the 90 days before and the 180 days after the start of therapy. Suicide attempts were highest in the month before therapy began, fell significantly during the first month of treatment, and declined steadily thereafter. This pattern held for treatment with antidepressants or psychotherapy. And although suicide attempt rates were higher in adolescents and young adults, the time patterns remained the same.
The second study examined Veterans Administration records of some 225,000 patients with new depression. Suicide attempt rates were lower among those treated with antidepressants, especially SSRIs or tricyclics, than among those who didn't receive drug therapy. Again, rates were higher before treatment than after.
An editorialist writes that while the studies do not prove that therapy reduces risk, they support the conclusion that "it is much more likely that suicidal behavior leads to treatment than that treatment leads to suicidal behavior."
Writing in Journal Watch Psychiatry, Joel Yager comments: "These association studies do not preclude the fact that a minority of younger patients may well experience an increase in suicidal ideation and perturbation when they start antidepressant medications and bear close follow-up during treatment initiation."