No association seen between suicide, SSRIs among children in Sweden.STOCKHOLM -- In Sweden, there is no evidence of an association between suicide and the use of selective serotonin reuptake inhibitors among children or adolescents; instead, these drugs appear to be associated with a decreased risk of suicide in the general population.
About 95% of suicides in Sweden are investigated in a process that includes a forensic toxicology screen, and antidepressants are among the drugs identified, Goran Isacsson, M.D., said at the annual congress of the European College of Neuropsychopharmacology.
Dr. Isacsson compared the toxicologic results from 14,857 suicides that occurred from 1992 to 2000 with those of 26,422 natural or accidental deaths during the same period.
His analysis indicated a decreased association with suicide for three serotonin reuptake inhibitors (SSRIs): fluoxetine (relative risk of 0.91), paroxetine (RR 0.87), and citalopram citalopram /ci·tal·o·pram/ (si-tal´o-pram)
1. an antidepressant compound used in the treatment of major depressive disorder, administered orally as the hydrobromide.
2. (RR 0.76). Sertraline sertraline /ser·tra·line/ (ser´trah-len) a selective serotonin reuptake inhibitor used as the hydrochloride salt in the treatment of depression, obsessive-compulsive disorder, and panic disorder. showed a slightly increased association with suicide (RR 1.05), while fluvoxamine fluvoxamine /flu·vox·amine/ (floo-vok´sah-men) a selective serotonin reuptake inhibitor, used as the maleate salt to relieve the symptoms of obsessive-compulsive disorder. showed a significantly increased association (RR 3.04).
"This increased risk can probably be explained by the fact that fluvoxamine was the first SSRI introduced in Sweden and was prescribed for patients who didn't respond to other medications," Dr. Isacsson suggested.
The association between SSRIs and suicide was even lower among children and adolescents, he said. There were 52 suicides among children up to 15 years old. Of those children, seven were taking antidepressants: five, a tricyclic antidepressant; one, venlafaxine venlafaxine /ven·la·fax·ine/ (ven?lah-fak´sen) an inhibitor of serotonin and norepinephrine reuptake that potentiates neurotransmitter activity in the central nervous system; used as the hydrochloride salt as an antidepressant and ; and one, mianserin. "None of these children were taking an SSRI--the most commonly prescribed antidepressant in this age group," Dr. Isacsson said. There were 356 suicides among children aged 15-19 years; 13 children had been taking an antidepressant, but only 6 of that group had been taking an SSRI. "That was not significant when compared to the controls," he said.
BY MICHELE G. SULLIVAN