Comparative Safety of Antidepressant Agents for Children and Adolescents Regarding Suicidal Acts

Overview

Journal Pediatrics

Specialty Pediatrics

Date 2010 Apr 14

PMID 20385637

Citations 26

Authors

Sebastian Schneeweiss

Amanda R Patrick

Daniel H Solomon

Colin R Dormuth

Matt Miller

Jyotsna Mehta

Jennifer C Lee

Philip S Wang

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study was to assess the risk of suicide attempts and suicides after initiation of antidepressant medication use by children and adolescents, for individual agents.

Methods: We conducted a 9-year cohort study by using population-wide data from British Columbia. We identified new users of antidepressants who were 10 to 18 years of age with a recorded diagnosis of depression. Study outcomes were hospitalization attributable to intentional self-harm and suicide death.

Results: Of 20,906 children who initiated antidepressant therapy, 16,774 (80%) had no previous antidepressant use. During the first year of use, we observed 266 attempted and 3 completed suicides, which yielded an event rate of 27.04 suicidal acts per 1000 person-years (95% confidence interval [CI]: 23.9-30.5 suicidal acts per 1000 person-years). There were no meaningful differences in the rate ratios (RRs) comparing fluoxetine with citalopram (RR: 0.97 [95% CI: 0.54-1.76]), fluvoxamine (RR: 1.05 [95% CI: 0.46-2.43]), paroxetine (RR: 0.80 [95% CI: 0.47-1.37]), and sertraline (RR: 1.02 [95% CI: 0.56-1.84]). Tricyclic agents showed risks similar to those of selective serotonin reuptake inhibitors (RR: 0.92 [95% CI: 0.43-2.00]).

Conclusion: Our finding of equal event rates among antidepressant agents supports the decision of the Food and Drug Administration to include all antidepressants in the black box warning regarding potentially increased suicidality risk for children and adolescents beginning use of antidepressants.

Citing Articles

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References

Braitman L, Rosenbaum P . Rare outcomes, common treatments: analytic strategies using propensity scores. Ann Intern Med. 2002; 137(8):693-5. DOI: 10.7326/0003-4819-137-8-200210150-00015. View

Dubicka B, Hadley S, Roberts C . Suicidal behaviour in youths with depression treated with new-generation antidepressants: meta-analysis. Br J Psychiatry. 2006; 189:393-8. DOI: 10.1192/bjp.bp.105.011833. View

Jick H, Kaye J, Jick S . Antidepressants and the risk of suicidal behaviors. JAMA. 2004; 292(3):338-43. DOI: 10.1001/jama.292.3.338. View

Hammad T, Laughren T, Racoosin J . Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006; 63(3):332-9. DOI: 10.1001/archpsyc.63.3.332. View

Walker A . Confounding by indication. Epidemiology. 1996; 7(4):335-6. View

Iribarren C, Sidney S, Jacobs Jr D, Weisner C . Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population. Soc Psychiatry Psychiatr Epidemiol. 2000; 35(7):288-96. DOI: 10.1007/s001270050241. View

Schneeweiss S, Avorn J . A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol. 2005; 58(4):323-37. DOI: 10.1016/j.jclinepi.2004.10.012. View

Hetrick S, Merry S, McKenzie J, Sindahl P, Proctor M . Selective serotonin reuptake inhibitors (SSRIs) for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2007; (3):CD004851. DOI: 10.1002/14651858.CD004851.pub2. View

Freiman J, CHALMERS T, SMITH Jr H, Kuebler R . The importance of beta, the type II error and sample size in the design and interpretation of the randomized control trial. Survey of 71 "negative" trials. N Engl J Med. 1978; 299(13):690-4. DOI: 10.1056/NEJM197809282991304. View

10.

Valuck R, Libby A, Sills M, Giese A, Allen R . Antidepressant treatment and risk of suicide attempt by adolescents with major depressive disorder: a propensity-adjusted retrospective cohort study. CNS Drugs. 2004; 18(15):1119-32. DOI: 10.2165/00023210-200418150-00006. View

11.

Mosholder A, Willy M . Suicidal adverse events in pediatric randomized, controlled clinical trials of antidepressant drugs are associated with active drug treatment: a meta-analysis. J Child Adolesc Psychopharmacol. 2006; 16(1-2):25-32. DOI: 10.1089/cap.2006.16.25. View

12.

Greenland S, Robins J . Confounding and misclassification. Am J Epidemiol. 1985; 122(3):495-506. DOI: 10.1093/oxfordjournals.aje.a114131. View

13.

Dormuth C, Glynn R, Neumann P, MacLure M, Brookhart A, Schneeweiss S . Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clin Ther. 2006; 28(6):964-78. DOI: 10.1016/j.clinthera.2006.06.007. View

14.

Tiihonen J, Lonnqvist J, Wahlbeck K, Klaukka T, Tanskanen A, Haukka J . Antidepressants and the risk of suicide, attempted suicide, and overall mortality in a nationwide cohort. Arch Gen Psychiatry. 2006; 63(12):1358-67. DOI: 10.1001/archpsyc.63.12.1358. View

15.

Olfson M, Marcus S, Shaffer D . Antidepressant drug therapy and suicide in severely depressed children and adults: A case-control study. Arch Gen Psychiatry. 2006; 63(8):865-72. DOI: 10.1001/archpsyc.63.8.865. View

16.

Maldonado G, Greenland S . Simulation study of confounder-selection strategies. Am J Epidemiol. 1993; 138(11):923-36. DOI: 10.1093/oxfordjournals.aje.a116813. View

17.

Martinez C, Rietbrock S, Wise L, Ashby D, Chick J, Moseley J . Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study. BMJ. 2005; 330(7488):389. PMC: 549107. DOI: 10.1136/bmj.330.7488.389. View

18.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

19.

Schneeweiss S, Rassen J, Glynn R, Avorn J, Mogun H, Brookhart M . High-dimensional propensity score adjustment in studies of treatment effects using health care claims data. Epidemiology. 2009; 20(4):512-22. PMC: 3077219. DOI: 10.1097/EDE.0b013e3181a663cc. View

20.

Didham R, McConnell D, Blair H, Reith D . Suicide and self-harm following prescription of SSRIs and other antidepressants: confounding by indication. Br J Clin Pharmacol. 2005; 60(5):519-25. PMC: 1884935. DOI: 10.1111/j.1365-2125.2005.02480.x. View