Article Text

Suicide-related events in young people following prescription of SSRIs and other antidepressants: a self-controlled case series analysis
  1. Linda P M M Wijlaars1,
  2. Irwin Nazareth1,
  3. Heather J Whitaker2,
  4. Stephen J W Evans3,
  5. Irene Petersen1
  1. 1Department of Primary Care and Population Health, University College London Medical School, London, UK
  2. 2Department of Mathematics and Statistics, The Faculty of Mathematics, Computing and Technology, The Open University, Milton Keynes, Buckinghamshire, UK
  3. 3Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Ms Linda P M M Wijlaars; linda.wijlaars.10{at}ucl.ac.uk

Abstract

Objectives We aimed to examine the temporal association between selective serotonin reuptake inhibitors (SSRI) and tricyclic antidepressant (TCA) prescriptions and suicide-related events in children and adolescents.

Design Self-controlled case series.

Setting Electronic health records were used from 479 general practices in The Health Improvement Network (THIN) UK primary care database from 1995 to 2009.

Participants 81 young people aged 10–18 years with a record of completed suicide, 1496 who attempted suicide, 1178 with suicidal ideation and 2361 with intentional self-harm.

Main outcome measures Incidence Rate Ratios (IRRs) for completed and attempted suicide, suicidal ideation and intentional self-harm.

Results For non-fatal suicide-related behaviour, IRRs were similar for the time the person was prescribed either SSRIs or TCAs: IRRs increased during pre-exposure, peaked on prescription day, were stable up to the fourth prescription-week, and decreased after the prescriptions were stopped. For both types of antidepressants, IRRs were lower or similar to pre-exposure levels during the period of prescription. For SSRIs, there was an increase in the IRR for completed suicide on the day of prescription (N=5; IRR=42.5, 95% CI 4.5 to 403.4), and during the fourth week of SSRI prescription (N=2; IRR=11.3, 95% CI 1.1 to 115.6).

Conclusions We found that a very small number of young people were prescribed antidepressants and that there was an absence of a sustained increase in rates of suicide-related events in this group. There were no systematic differences between the association of TCAs and SSRIs and the incidence risk ratios for attempted suicide, suicidal ideation or intentional self-harm and, apart from the day of prescription, rates did not exceed pre-exposure levels. The pattern of IRR for suicide for SSRIs was similar to that found in non-fatal suicide-related events. Our results warrant a re-evaluation of the current prescription of SSRIs in young people. We recommend the creation of a pragmatic registry for active pharmacovigilance.

  • Epidemiology
  • Mental Health
  • Suicide & Self-Harm < Psychiatry
  • Depression & Mood Disorders < Psychiatry

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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