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No apparent difference in suicide risk between older and newer antidepressants although older drugs may increase risk of suicide attempt during the first month of treatment

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Q Is suicide risk related to antidepressant type (newer or older antidepressant) or greater in the first month after treatment initiation?


Embedded ImageDesign:

Retrospective cohort study.

Embedded ImageFollow up period:

6 months following initial antidepressant prescription.

Embedded ImageSetting:

Members of a prepaid health plan in Washington and Idaho, USA.

Embedded ImagePeople:

65 203 people starting a new episode of antidepressant treatment between January 1992 and June 2003.

Embedded ImageRisk factors:

Treatment with a newer antidepressant (bupropion, citalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, escitalopram, venlafaxine) or older antidepressant (primarily tricyclic antidepressants (76%) and trazodone (21%)).

Embedded ImageOutcomes:

Suicide attempt requiring hospitalisation (verified through hospital discharge records) or death by suicide (verified through death certificate).


The newer antidepressants did not increase risk of suicide attempt or suicide death …

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  • For correspondence: Dr G E Simon, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Number 1600, Seattle WA 98101, USA; simon.g{at}

  • Sources of funding: Supported by the National Institute of Mental Health; principal investigator has received a grant from Eli Lilly & Co, and consulted in a patient education programme funded by Pfizer Pharmaceuticals.