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Cited by 277Suicide and Self-Harm StudiesTreatment of Major DepressionBipolar Disorder and Treatment

Antidepressants and the Risk of Suicide, Attempted Suicide, and Overall Mortality in a Nationwide Cohort

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Tiihonen, Jari, Lönnqvist, Jouko, Wahlbeck, Kristian, Klaukka, Timo, Tanskanen, Antti, Haukka, Jari·2006·Archives of General Psychiatry
DOI 10.1001/archpsyc.63.12.1358
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Abstract

BACKGROUND: It is unknown if antidepressant treatment is associated with either increased or decreased risk of suicide. OBJECTIVE: To estimate the risk of suicide, attempted suicide, and overall mortality during antidepressant treatments in a real-life setting with high statistical power. DESIGN AND SETTING: A cohort study in which all subjects without psychosis, hospitalized because of a suicide attempt from January 1, 1997, to December 31, 2003, in Finland, were followed up through a nationwide computerized database. PARTICIPANTS: A total of 15 390 patients with a mean follow-up of 3.4 years. MAIN OUTCOME MEASURES: The propensity score-adjusted relative risks (RRs) during monotherapy with the most frequently used antidepressants compared with no antidepressant treatment. RESULTS: In the entire cohort, fluoxetine use was associated with the lowest risk (RR, 0.52; 95% confidence interval [CI], 0.30-0.93), and venlafaxine hydrochloride use with the highest risk (RR, 1.61; 95% CI, 1.01-2.57), of suicide. A substantially lower mortality was observed during selective serotonin reuptake inhibitor use (RR, 0.59; 95% CI, 0.49-0.71; P<.001), and this was attributable to a decrease in cardiovascular- and cerebrovascular-related deaths (RR, 0.42; 95% CI, 0.24-0.71; P=.001). Among subjects who had ever used any antidepressant, the current use of medication was associated with a markedly increased risk of attempted suicide (39%, P<.001), but also with a markedly decreased risk of completed suicide (-32%, P=.002) and mortality (-49%, P<.001), when compared with no current use of medication. The results for subjects aged 10 to 19 years were basically the same as those in the total population, except for an increased risk of death with paroxetine hydrochloride use (RR, 5.44; 95% CI, 2.15-13.70; P<.001). CONCLUSIONS: Among suicidal subjects who had ever used antidepressants, the current use of any antidepressant was associated with a markedly increased risk of attempted suicide and, at the same time, with a markedly decreased risk of completed suicide and death. Lower mortality was attributable to a decrease in cardiovascular- and cerebrovascular-related deaths during selective serotonin reuptake inhibitor use.

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  • Some observational studies and a secondary analysis from a psychotherapy trial in cardiac patients have found that prescription of antidepressants, specifically selective serotonin reuptake inhibitors, is associated with lower rates of cardiovascular mortality or myocardial infarction.

    “Some observational studies and a secondary analysis from a psychotherapy trial in cardiac patients have found that prescription of antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), is associated with lower rates of cardiovascular mortality 167,168 or MI. 169”

    From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [167]

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Research works printed but not linked: 2

  1. Middleton N, Gunnell D, Whitley E, Dorling D, Frankel S. Secular trends in anti- depressant prescribing in the UK, 1975-1988. J Public Health Med. 2001;23: 262-267.
  2. Lo ¨nnqvist J, Henriksson M, Isometsa ¨E, Marttunen M, Heikkinen M. Itsetuhoka ¨y- tta ¨ytyminen ja itsemurhat. In: Lo ¨nnqvist J, Heikkinen M, Henriksson M, Mart- tunen M, Partonen T, eds. Psykiatria. Ha ¨meenlinna, Finland: Duodecim; 2006: 589-603. .

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Authors
Tiihonen, J., Lönnqvist, J., Wahlbeck, K., Klaukka, T., Tanskanen, A., & Haukka, J.
Affiliations
Niuvanniemi Hospital (FI)
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2006-12-01
Volume
63
Issue
12
Pages
1358-67
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.63.12.1358
OpenAlex
W2151499150
Cited by
277
References
38
Citations by year
2026: 3 · 2025: 3 · 2024: 8 · 2023: 5 · 2022: 5 · 2021: 8 · 2020: 5 · 2019: 7 · 2018: 21 · 2017: 5 · 2016: 19 · 2015: 16 · 2014: 19 · 2013: 12 · 2012: 16
FWCI
28.41
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
antidepressants, suicide, suicide attempts, mortality, fluoxetine, venlafaxine, paroxetine, selective serotonin reuptake inhibitors, cardiovascular mortality, cerebrovascular disease mortality, adolescents, depression treatment
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Antidepressive Agents, Cause of Death, Child, Depressive Disorder, Female, Finland, Follow-Up Studies, Hospitalization, Humans, Male, Middle Aged, Registries, Risk Factors, Suicide, Suicide, Attempted, Cohort Studies, Proportional Hazards Models, Selective Serotonin Reuptake Inhibitors

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