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Antidepressants and suicidal behaviour in unipolar depression
B I Yerevanian1, R J Koek, J D Feusner
1Sepulveda Ambulatory Care Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. byerevan@ucla.edu
Acta Psychiatrica Scandinavica
|November 4, 2004
Summary
Antidepressant treatment discontinuation significantly increases suicidal behavior risk in patients with unipolar depression. Both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) appear to offer a protective effect during treatment.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Research
Background:
- Suicidal behavior is a significant concern in patients with major depressive disorder.
- Understanding the impact of antidepressant treatment and discontinuation on suicidality is crucial for patient safety.
Purpose of the Study:
- To compare suicidal behavior rates during and after antidepressant discontinuation.
- To compare suicidal behavior rates between selective serotonin reuptuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).
Main Methods:
- Retrospective chart review of 521 patients diagnosed with major depressive disorder and/or dysthymic disorder.
- Analysis of suicidal behavior rates (completed suicide, attempts, hospitalizations) during active treatment and discontinuation phases for SSRIs and TCAs.
Main Results:
- A greater than five-fold increase in suicidal behavior risk was observed after antidepressant discontinuation (P < 0.0001).
- Suicidal behavior rates were similar for patients treated with SSRIs and TCAs.
Conclusions:
- Antidepressant discontinuation is associated with a substantial increase in suicidal behavior in unipolar depression.
- Both SSRIs and TCAs may have a protective effect against suicidal behavior during treatment.
- These findings highlight the importance of careful monitoring during antidepressant discontinuation.