Psychiatr News August 3, 2007
Volume 42, Number 15, page 1
© 2007 American Psychiatric Association
Suicide Attempts Decline With Psychotherapy or Antidepressants
Joan Arehart-Treichel
A recent study finds that suicide attempts decreased after initiation of
treatment with antidepressant medication or psychotherapy.
Results from two studies reported in the July American Journal of
Psychiatry bolster the position that antidepressants prevent suicides,
not cause them.
In the first study, two researchers at the Center for Health Studies of the
Group Health Cooperative in Seattle—Gregory Simon, M.D., and James
Savarino, Ph.D.—studied suicide-attempt patterns among 109,256
individuals in the Group Health Cooperative who were starting treatment for
depression. The Group Health Cooperative is a prepaid health plan serving
about 500,000 members in Washington state and northern Idaho. The individuals
fell into three groups—those receiving antidepressants from a primary
care doctor, those receiving antidepressants from a psychiatrist, and those
receiving psychotherapy.
More notable, the researchers found the same time pattern of suicidal
attempts in all three groups. The incidence was highest in the month before
the start of treatment and declined steadily over a six-month period after
treatment began.
The investigators then restricted their analyses to patients less than 25
years old, since concern about antidepressants possibly triggering suicides
has focused primarily on that age group. Across all three groups, the overall
incidence of suicide attempts was about twice as high as in the full subject
sample. Nonetheless, adolescents and younger adults showed the same time
pattern of suicidal attempts in all three groups as the full subject sample
did.
The overall incidence of suicide attempts during the study period was
highest among patients receiving antidepressant treatment from a psychiatrist;
slightly lower among patients starting psychotherapy, and much lower among
patients starting antidepressant treatment in primary care. "We do not
interpret this difference as evidence that psychiatric care increases the risk
of suicide," Simon and Savarino wrote. "Instead, we would conclude
that...patients at higher risk for suicide attempts are more often referred
for psychiatric care."
In the second study, Robert Gibbons, Ph.D., of the University of Illinois
at Chicago, and coworkers studied 226,866 veterans diagnosed with depression
during 2003 and 2004. They found not only a decrease in suicidal attempts
among the subjects once treatment began, but also a lower rate of suicidal
attempts in depressed veterans who took antidepressants compared with those
who did not (see VA Finds Antidepressants Reduce Suicide Risk).
"The study by Simon and colleagues is very interesting and
helpful," David Fassler, M.D., a clinical professor of psychiatry at the
University of Vermont and an APA trustee-at-large, told Psychiatric
News. "It confirms the general clinical consensus that treatment
for depression, including treatment with medication, is associated with a
significant reduction in suicide attempts. The take-home message is: if you
think you're depressed, get help. Treatment works. The findings should be
reassuring to physicians and patients.
"This study also highlights the growing concerns about the impact of
the FDA's decision to add black-box warnings to all antidepressant
medications. As a result of this action and the related media coverage, we've
seen a precipitous decline in the use of these medications in the treatment of
children and adolescents. Tragically, we've also seen the first increase in
the actual adolescent suicide rate since the early 1990's."
"These studies of treatment in actual clinical practice find a
decrease in suicide attempts after treatment, regardless of whether the
treatment is psychotherapy or drug therapy," AJP Editor in
Chief Robert Freedman, M.D., observed. "Patients and their doctors are
concerned because of the FDA's black-box warning that antidepressants can
cause suicide attempts. The studies in this issue provide more evidence that
this side effect is rare, compared to the overall decrease in suicide attempts
that occurs when treatment is initiated. Furthermore, suicide attempts in the
first month of treatment [can] occur regardless of whether the treatment is
psychotherapy or drug therapy, which suggests that these attempts are part of
the natural evolution of symptoms in depression itself."
Even though both studies bolster the position that antidepressants protect
against suicide, not cause it, they do not rule out the possibility that
antidepressants may increase suicide risk in a vulnerable subgroup of
patients, Simon and Savarino stressed in their study report. The reason why,
they explained, is that "randomized trials or large observational
studies can only examine average effects." "Given this
uncertainty," they concluded, "prescribers should certainly heed
recommendations by the U.S. Food and Drug Administration to advise patients
about their risk and to maintain close contact after patients start
medication."
The two studies were funded by the National Institute of Mental Health.
"Suicide Attempts Among Patients Starting Depression Treatment
With Medications or Psychotherapy" and "Relationship Between
Antidepressants and Suicide Attempts: An Analysis of the Veterans Health
Administration Data Sets" are posted at
<http://ajp.psychiatryonline.org>
under the July issue. 
Related Article:
-
VA Finds Antidepressants Reduce Suicide Risk in Vets
- Aaron Levin
Psychiatr News 2007 42: 8.
[Full Text]
Get information about faster international access.
Privacy Policy
Copyright © 2007
American Psychiatric Association.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
| 
