Approximately 1 million bodily sub...

Approximately 1 million bodily substances worldwide commit suicide each year. In the United States, the number of deaths from suicide through the whole extent of the past 20 years caped the number of deaths from acquired immunodeficiency syndrome More than 90 percent of individuals who commit suicide have psychiatric illnesses; vein disorders are most commonly associated with suicide. greatest in number persons with these disorders who commit suicide pursue professional help in the month before their death; however, at the time of suicide, in the greatest degree are untreated. This suggests that the lack of treatment of temper disorders may contribute to the risk of suicide. newly come information adds to the trouble that selective serotonin reuptake inhibitors (SSRIs) may increase the risk of suicide, particularly in children. There generally are no randomized trials that can verify or disprove this theory, and any so trial would be difficult to perform because of the large number of patients that would have to be treated for sweeps to be observed. Gibbons and colleagues used a national database to evaluate the relationship between antidepressant medication prescription and suicide rates.

Data forward suicide rates were obtained from the National Center for Health Statistics of the Center for Disease direction and Prevention. The data masked every county in the United States and were wasted down by sex, race, and age dispose (i.e., five to 14 years, 15 to 24 25 to 44 45 to 64 and 65 years and older) Data forward the use of antidepressants were drawn from a national pharmacy database that did not include hospital prescription information. The antidepressant prescription data were divided into three groups: tricyclic antidepressants (TCAs), SSRIs, and others. The main issue measures were the suicide rate in each shire and the impact of antidepressant use.

A regression protoplast was used to adjust for age, sex and race differences among counties, and the observ suicide rates matched well with count uponed rates (i.e., increase with age, higher in men lower in blacks). The authors of the contemplation found no significant relationship between the use of antidepressant medications and suicide rates. Prescriptions for SSRIs and new-generation non-SSRI antidepressants were associated with lower suicide rates. The suicide rate was higher in counties that had a higher use of TCAs. Suicide rates were higher in rural counties, which had fewer antidepressant prescriptions, lower income, and more prescriptions for TCAs. There was no significant change in suicide rates with regard to age and use of non-TCA antidepressants.

Although greater prescription use of SSRIs and new-generation non-SSRIs was associated with lower suicide rates in this meditation and the use of TCAs was associated with an increase in suicide rates, the authors finish that a direct causal relationship cannot be assumed. A high number of TCA prescriptions in any single in kind county may be indicative of limited access to high-quality health care and other factors, and the association between lower suicide rates and SSRI or non-SSRI antidepressants may be attributable to the effectiveness of the medications, greater patient compliance, access to better-quality mental health care, and the lower toxicity of these medications in the fact of a suicide attempt.

KARL E MILLER, MD

Gibbons RD et al. The relationship between antidepressant medication use and rate of suicide. Arch Gen Psychiatry February 2005;62:165-72

EDITOR'S NOTE: The U nutrition and Drug Administration (FDA) stated in a health care advisory that preliminary data hint that treatment with selective serotonin reuptake inhibitors (SSRIs) may increase suicide rates in children (1) and should be used with caution in this population. Gibbons and colleagues hint that suicide rates are lower in someones treated with SSRIs; however, this is a population-based research that has some limitations in its general application. Unfortunately, a reflection large enough to determine the impact this class of unsalable articles may have on suicide rates would be difficult to perform. The message chiefly useful for physicians comes from the FDA, which reminds us that the possibility of suicide is inherent in patients with major depressive disorders, and that these patients should be supervised closely after treatment is initiated. (1)--KEM

REFERENCE

(1) FDA public health advisory: reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder (MDD) October 27 2003 Accessed online March 18 2005 at: http://www.fda.gov/cder/drug/advisory/mdd.htm.

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