Antidepressants and suicide in young people Ppt Powerpoint Presentation slides Professor Robert Goldney Medical Slideshow Antidepressant Induced Suicide and Tort Reform

Antidepressants and suicide in young people

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Slide 1 :

Antidepressants and suicide in young people Medical Journal of Australia, 2007, 187:886-887 Professor Robert D Goldney Discipline of Psychiatry University of Adelaide

Slide 2 :

Community and professional concerns There have been concerns that the newer antidepressants may precipitate suicidal behaviour, particularly in young persons.

Slide 3 :

Emergent suicidal thinking is open to interpretation in terms of causality Even non-pharmacological treatment for depression in adolescents has been associated with emergent suicidality “rates similar to those reported recently in antidepressant trials” (Bridge et al, Am J Psychiatry, 2005)

Slide 4 :

However, idiosyncratic responses to any medications can not be ruled out. RCTs have limitations

Slide 5 :

RCT limitations It is ethical to not treat those with suicidal ideation/behaviour? Low base rate of suicide preclude sufficient numbers for meaningful analysis Not “real life” with many uncontrollable variables

Slide 6 :

Naturalistic studies Large scale naturalistic studies can inform clinical practice “non-experimental methods may be the only source of guidance for policy makers” (Ludwig & Marcotte, J Policy Management Analysis, 2005)

Slide 7 :

Combination of all available international SSRI data Ludwig and Marcotte, J Policy Analysis Management 2005 SSRI and suicide data from 27 countries Suicide rates fell fastest in those countries that experienced the most rapid rate of growth in SSRI sales Suicide rate in 1999 would have been 17% higher than 1990 but for SSRIs. Relationship more pronounced for adults than children.

Slide 8 :

Need for further studies Associations in research do not necessarily imply a causal relationship Nevertheless, such reports are persuasive for most clinicians and researchers However, there has been concern that the newer antidepressants may precipitate suicide in some individuals

Slide 9 :

Need for different studies If antidepressants precipitate suicide, then they should be present in some of those young persons who die by suicide. There are now data from five studies of young persons who have died by suicide

Slide 10 :

Antidepressants and the risk of suicidal behaviours Use of UK General Practice Research Database (GPRD) 35 million patient years of information Very rigorous methodology amitriptyline 36,165 dothiepin 46,587 fluoxetine 49,671 paroxetine 35,465 Jick et al, JAMA 2004

Slide 11 :

Antidepressants and the risk of suicidal behaviours Similar risks of suicidal behaviour after starting: amitriptyline dothiepin fluoxetine paroxetine Jick et al, JAMA 2004

Slide 12 :

Adolescent suicide in Jick et al study No suicides fulfilled criteria of being on the study drugs But, 15 in that age group on GPRD did die by suicide, none of whom had received an antidepressant drug Jick et al, JAMA 2004 For those aged 10–19 years:

Slide 13 :

SSRIs and suicide in Sweden Toxicological screening of 14,857 suicides 1992–2000 26,422 controls (accidents/natural causes) SSRIs under-represented compared with other antidepressants OR = 0.83 (99% CI: 0.77–0.90) Isacsson et al, Acta Psychiatr Scand 2005

Slide 14 :

SSRIs and suicide in Sweden In 15 – 19 years age group: SSRIs lower relative risk (RR) 0.14 (95% CI: 0.05 – 0.43) for suicide compared to non-SRRIs In < 15 years age group: 52 suicides – no SSRIs detected by toxicological screening Isacsson et al, Acta psychiatr Scand 2005

Slide 15 :

Psychotropics and youth suicides in USA Moskos et al, SLTB 2005 49 suicides aged 13 – 21 years between 1996 and 1998 “not one demonstrated therapeutic or sub-therapeutic levels of psychotropic medications upon autopsy”.

Slide 16 :

SSRIs and youth suicide in Denmark Sondergard, European CAP 2006 Youth Suicide in Denmark, 1995 – 1999 None of the 42 suicides aged 10 to 17 years had been treated with SSRIs in the two weeks prior to death None of the 37 boys who died by suicide had ever been treated with antidepressants

Slide 17 :

Antidepressants and youth suicide in New York Leon et al, 2006 36 suicides under the age of 18 Only one had evidence of ADs in toxicological analysis “the detection of antidepressants at autopsy was quite rare”

Slide 18 :

Summary of SSRI use in young persons who died by suicide ____________________ Researchers Country Ages (yrs) No. of SSRI suicides antidepressants before suicide ___________ Jick et al (2004) U.K. 10 – 19 15 0 Isacsson et al (2005) Sweden < 15 52 0 Moskos et al (2005) US 13 – 21 49 0 Sondergard et al (2006)Denmark 10 – 17 42 0 Leon et al (2006) US < 18 36 1 _____________________________________ Total 194 1 ________________________

Slide 19 :

The virtual absence of antidepressants in young persons who have died by suicide in 5 studies from 4 different countries is quite incongruent with the hypothesis that antidepressants precipitate suicide in young persons

Slide 20 :

Depression in young persons who have died by suicide A comprehensive study has demonstrated that: Two thirds had mood disorders at the time of suicide Shaffer et al (Arch of Gen. Psychiatry, 1996)

Slide 21 :

A question: Why was only one out of 194 young persons who died by suicide on antidepressants at the time of their death when it is probable that two thirds had significant mood disorders?

Slide 22 :

Anti-depressants and depression in young persons This presentation should not be taken as uncritically endorsing the use of antidepressants in depressed young persons.

Slide 23 :

Anti-depressants and depression in young persons - They are only approved for major depression - They should be accompanied by non-pharmacological techniques as well - There must be close monitoring for any potential side-effects

	robert.goldney@adelaide.edu.ad 1 Years ago. Category: Psychiatry

Tags:	Psychiatry

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