Suïcidaal gedrag vóór en na start antidepressiva*

Objective

A causal relationship between antidepressants (ADs) and high risk of suicide behavior at young age has been suggested. We analyzed the rates of suicide attempts during treatment with AD in comparison with the rates before treatment initiation for different ages.

Design

Observational retrospective cohort study.

Method

Claims of insurance company Achmea were used to establish the risk of a suicide attempt before and after start of treatment among patients with a first registered AD prescription in 2006-2011 (n = 66,196).

Results

Among those aged < 25 years, a high rate of suicide attempts during the month before the start was found (376.3/10,000 person yrs). A non-significant increase in the first month (p = 0.212) was found and a non-significant trend to lower values thereafter (p = 0.3050). Among those ≥ 25 years, a clear decrease to lower rates immediately after the start was observed (p < 0.025). The highest rates of suicide were found among those > 40 years during the first month. Female gender was, but treatment characteristics were not associated with early attempts at young age.

Conclusion

Among young AD users, high pre-treatment risk of suicide attempts was present and persisted during the early phases after the start. This contrasted with the clear decrease in risk among those aged ≥25 years, suggesting lower immediate effectiveness of ADs to prevent suicidal behavior at young ages. Caution should be exercised to infer a causal relationship or to use data on attempts to predict risk of suicide during AD use.

Conflict of interest and financial support: This work was supported by grants from the Netherlands Foundation for Mental Health and the Netherlands Organisation for Health Research and Development (ZonMw). ICMJE forms provided by the authors are available online along with the full text of this article.