Journal
INTERNATIONAL JOURNAL OF NEUROPSYCHOPHARMACOLOGY
Volume 21, Issue 9, Pages 814-821Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ijnp/pyy048
Keywords
antidepressants; SSRI; adverse drug reaction; suicide; drug safety
Funding
- Astra Zeneca Osterreich GmbH
- Boehringer Ingelheim Austria
- Bristol Myers Squibb GmbH
- CSC Pharmaceuticals GmbH
- Eli Lilly GmbH
- Germania Pharma GmbH
- GlaxoSmithKline Pharma GmbH
- Janssen-Cilag Pharma GmbH
- Lundbeck GmbH
- Novartis Pharma GmbH
- Pfizer Med Inform
- Wyeth Lederle Pharma GmbH
- Abbott GmbH Co. KG
- AstraZeneca GmbH
- Aventis Pharma Deutschland GmbH GE-O/R/N
- Bayer Vital GmbH Co. KG
- Boehringer Mannheim GmbH
- Bristol-Myers-Squibb
- Ciba Geigy GmbH
- Desitin Arzneimittel GmbH
- Duphar Pharma GmbH Co. KG
- Eisai GmbH
- esparma GmbH Arzneimittel
- GlaxoSmithKline Pharma GmbH Co. KG
- Hoffmann-La Roche AG Medical Affairs
- Janssen-Cilag GmbH
- Janssen Research Foundation
- Knoll Deutschland GmbH
- Lilly Deutschland GmbH Niederlassung Bad Homburg
- Lundbeck GmbH Co. KG
- Nordmark Arzneimittel GmbH
- Organon GmbH
- Otsuka-Pharma Frankfurt
- Pfizer GmbH
- Pharmacia Upjohn GmbH
- Promonta Lundbeck Arzneimittel
- Rhone-Poulenc Rohrer
- Sanofi-Synthelabo GmbH
- Sanofi-Aventis Deutschland
- Schering AG
- SmithKline Beecham Pharma GmbH
- Solvay Arzneimittel GmbH
- Synthelabo Arzneimittel GmbH
- Dr. Wilmar Schwabe GmbH Co.
- Thiemann Arzneimittel GmbH
- Troponwerke GmbH Co. KG
- Upjohn GmbH
- Wander Pharma GmbH
- Wyeth-Pharma GmbH
- AHP (Schweiz) AG
- AstraZeneca AG
- Bristol-Myers Squibb AG
- Desitin Pharma GmbH
- Eli Lilly (Suisse) S.A.
- Essex Chemie AG
- GlaxoSmithKline AG
- Janssen-Cilag AG
- Lundbeck (Suisse) AG
- Organon AG
- Pfizer AG
- Pharmacia
- Sanofi-Aventis (Suisse) S.A.
- Sanofi-Synthelabo SA
- Servier SA
- SmithKlineBeecham AG
- Solvay Pharma AG
- Wyeth AHP (Suisse) AG
- Wyeth Pharmaceuticals AG
- Angelini
- AOP Orphan Pharmaceuticals AG
- AstraZeneca
- Eli Lilly
- Janssen
- KRKA-Pharma
- Lundbeck
- Neuraxpharm
- Pfizer
- Pierre Fabre
- Schwabe
- Servier
- Lilly
- BMS
- Astra-Zeneca
- Bayer
Ask authors/readers for more resources
Background: Suicidal ideations, suicide attempts, and fatal suicides are rare adverse drug reactions to antidepressant drugs, but they essentially are clinically relevant. Drawing on a larger dataset of the European drug surveillance program, the present naturalistic study updates a previous contribution (Stikner et al., 2010). Methods: First an analysis of the comprehensive data collected in 81 psychiatric hospitals from 1993 to 2014 by the European drug surveillance program Arzneimittelsicherheit in der Psychiatrie was made. All documented single cases of suicidal ideations or behavior judged as adverse drug reactions to antidepressant drugs were carefully assessed as to their clinical features and drug prescriptions. Results: Among 219,635 adult hospitalized patients taking antidepressant drugs under surveillance, 83 cases of suicidal adverse drug reactions occurred (0.04%): 44 cases of suicidal ideation, 34 attempted suicides, and 5 committed suicides were documented. Restlessness was present in 42 patients, ego-dystonic intrusive suicidal thoughts or urges in 39 patients, impulsiveness in 22 patients, and psychosis in 7 patients. Almost all adverse drug reactions occurred shortly after beginning antidepressant drug medication or increasing the dosage. Selective serotonin reuptake inhibitors caused a higher incidence of suicidal ideation and suicidal behavior as adverse drug reactions than noradrenergic and specific serotonergic antidepressants or tricyclic antidepressants, as did monotherapy consisting of one antidepressant drug, compared to combination treatments. Conclusions: The study supports the view that antidepressant drug-triggered suicidal ideation and suicidal behavior (primarily with selective serotonin reuptake inhibitors) are rare. Special clinical features (restlessness, ego-dystonic thoughts or urges, impulsiveness) may be considered as possible warning signs. A combination therapy might be preferable to antidepressant drug monotherapy when beginning treatment.
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