Suicide risk during antidepressant treatment
Suicide risk during antidepressant treatment
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DOI：
10.1176/appi.ajp.163.1.41
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发表时间：
2006-01-01
影响因子：
17.7
通讯作者：
Wang, PS
中科院分区：
文献类型：
--
作者：
Simon, GE;Savarino, J;Wang, PS
目的：2004年3月，美国食品和药物管理局(FDA)警告医生和患者使用10种较新的抗抑郁药物会增加自杀风险。现有数据对抗抑郁药物治疗期间自杀未遂和自杀死亡的实际风险存在相当大的不确定性。作者使用基于人群的数据来评估与开始抗抑郁药物治疗有关的自杀死亡和严重自杀未遂的风险。方法：使用计算机化的健康计划记录来识别1992年1月1日至2003年6月30日期间的65,103名患者，82,285次抗抑郁药物治疗。通过使用州和国家死亡证明数据来确定自杀死亡。结果：在抗抑郁药物治疗指标处方后的6个月内，研究组共发现自杀死亡31例(40/10万次)，严重自杀未遂76例(93/10万次)。儿童和青少年自杀未遂的风险为每10万人中有314人自杀，而成年人为每10万人中有78人自杀。在开始服药后的一个月，自杀死亡的风险并没有明显高于随后的几个月。自杀企图的风险在开始抗抑郁药物治疗前一个月最高，开始药物治疗后逐渐下降。当FDA建议中的10种较新的抗抑郁药与旧药进行比较时，只有旧药在开始治疗后风险增加。结论：在急性期抗抑郁药治疗期间自杀的风险约为3000次治疗中的一次，严重自杀未遂的风险约为1000次中的一次。现有数据表明，在开始使用较新的抗抑郁药物治疗后，自杀或严重自杀未遂的风险没有显着增加。
Objective: In March 2004 the U. S. Food and Drug Administration (FDA) warned physicians and patients regarding increased risk of suicide with 10 newer antidepressant drugs. Available data leave considerable uncertainty regarding actual risk of suicide attempt and death by suicide during antidepressant treatment. The authors used population-based data to evaluate the risk of suicide death and serious suicide attempt in relation to initiation of antidepressant treatment.Method: Computerized health plan records were used to identify 65,103 patients with 82,285 episodes of antidepressant treatment between Jan. 1, 1992, and June 30, 2003. Death by suicide was identified by using state and national death certificate data. Serious suicide attempt (suicide attempt leading to hospitalization) was identified by using hospital discharge data.Results: In the 6 months after the index prescription of antidepressant treatment, 31 suicide deaths (40 per 100,000 treatment episodes) and 76 serious suicide attempts (93 per 100,000) were identified in the study group. The risk of suicide attempt was 314 per 100,000 in children and adolescents, compared to 78 per 100,000 in adults. The risk of death by suicide was not significantly higher in the month after starting medication than in subsequent months. The risk of suicide attempt was highest in the month before starting antidepressant treatment and declined progressively after starting medication. When the 10 newer antidepressants included in the FDA advisory were compared to older drugs, an increase in risk after starting treatment was seen only for the older drugs.Conclusions: The risk of suicide during acute-phase antidepressant treatment is approximately one in 3,000 treatment episodes, and risk of serious suicide attempt is approximately one in 1,000. Available data do not indicate a significant increase in risk of suicide or serious suicide attempt after starting treatment with newer antidepressant drugs.