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In people taking antidepressants, suicidal behaviour is less common when they are taking them than in unexposed periods

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What is the association between antidepressants and the risk of suicide?


757 adult participants (mean age 38.1 years; 61.8% women) of the Collaborative Depression Study being treated for depression (77.7%), mania (15.7%), schizoaffective-manic disorder (3.5%) or schizoaffective-depressed disorder (3.2%; diagnoses made using Research Diagnostic Criteria). At intake, mean Hamilton Depression Rating Scale was 20.2. Participants with comorbidities, receiving acute or maintenance therapies, polypharmacy or no psychopharmacologic treatment were included. Most participants had several periods of antidepressant use during follow up.


Five academic medical centres, USA; recruitment from 1978 to 1981.

Prognostic factors

Exposure to antidepressant medication. For each week of follow-up, participants were classified as being exposed or not exposed to antidepressants, irrespective of dose, specific antidepressant or use of other medications. The antidepressant exposure interval was the unit of analysis and defined as the period of consecutive weeks without a change in antidepressant status. Exposure intervals were ended by a suicide attempt or suicide death, change in antidepressant exposure status or end of follow-up. Antidepressant status and severity of symptoms were assessed twice a year for the first 5 …

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  • Sources of funding The National Institute of Mental Health was involved in the initial study design, but was not involved in the analysis.


  • Conflicting interests None.

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