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Suicide and antidepressants

S A Montgomery1

  • 1Imperial College of Medicine, St. Mary's London, United Kingdom. sam@montgomery.demon.co.uk

Annals of the New York Academy of Sciences
|June 9, 1998
PubMed
Summary

Suicidal thoughts are common in depression. Low-dose flupenthixol significantly lowered suicide attempts in high-risk patients, while some antidepressants increased attempts.

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Area of Science:

  • Psychiatry
  • Clinical Psychology
  • Pharmacology

Background:

  • Suicidal ideation and attempts are prevalent in various forms of depression, particularly major depression and recurrent brief depression.
  • Comorbid depression significantly elevates suicide attempt rates, with combined depression being a strong predictor.
  • Limited controlled studies exist for treating depression in high-risk suicide attempters.

Purpose of the Study:

  • To review existing controlled studies on treatments for depression in high-risk suicide attempters.
  • To identify treatments that may increase or decrease suicide attempt rates in these populations.
  • To provide guidance on antidepressant selection for at-risk individuals.

Main Methods:

  • Review of controlled studies investigating treatments for depression in individuals with a history of suicide attempts.
  • Analysis of findings regarding psychotherapy, fluoxetine, mianserin, flupenthixol, maprotiline, amitriptyline, and tricyclic antidepressants (TCAs).
  • Examination of coroner's data on antidepressant toxicity and overdose-related deaths.

Main Results:

  • Psychotherapy was associated with a higher suicide attempt rate compared to conventional treatment.
  • Fluoxetine and mianserin showed no significant difference from placebo.
  • Low-dose flupenthixol significantly reduced suicide attempt rates compared to placebo over six months.
  • Maprotiline and amitriptyline may increase suicide attempt rates.
  • TCAs are linked to high overdose death rates, unlike SSRIs and other safer antidepressants.

Conclusions:

  • Low-dose flupenthixol is the only identified treatment to lower suicide attempt rates in high-risk patients.
  • Certain antidepressants, particularly TCAs, should be avoided in individuals at high risk for suicide due to overdose risks.
  • Careful selection of antidepressants is crucial for depressed patients with a history of suicide attempts.

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