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Shitij Kapur, MD; Tammy Mieczkowski, MA; J. John Mann, MD

JAMA. 1992;268(24):3441-3445.

Abstract
Objective.
—Suicide by drug overdose is a major public health problem, and antidepressant medications are the most common agent involved. European studies suggest differences in the rates of suicide by overdose among antidepressants, but no reports have been published for the United States. We estimated the comparative risks of suicide attempts and suicides, and the relative risk of fatality in the event of an overdose for the major antidepressants currently marketed in the United States.

Data Sources.
—Information regarding suicide attempts and suicides by antidepressant overdose was obtained from the published reports of the Drug Abuse and Warning Network and the annual report of the American Association of Poison Control Centers, and corrected for differences in total annual prescriptions using data from the National Prescription Audit.

Results.
—The risk of a suicide attempt did not appear to differ among antidepressants. The tricyclic antidepressants were associated with a higher rate of death in the event of an overdose than the newer nontricyclic antidepressants in both the annual report of the American Association of Poison Control Centers and the Drug Abuse and Warning Network data. The chance of death after an overdose was greater for desipramine hydrochloride than for other tricyclics.

Conclusion.
—The higher risk of suicide with tricyclics vs nontricyclics may be explained by a higher rate of death from overdose rather than more suicide attempts. Tricyclics carry the risk of greater cardiotoxicity. The basis for the even higher rate of death/overdose of desipramine is not known and requires further research. If these findings are replicated in a case-control study design, they have important implications for the choice of an antidepressant for the depressed patient at risk for suicidal behavior.

(JAMA. 1992;268:3441-3445)

Author Affiliations
From the Mental Health Clinical Research Center for the Study of Suicidal Behavior, Laboratories of Neuropharmacology, Western Psychiatric Institute and Clinic, University of Pittsburgh (Pa).

Footnotes
Reprint requests to the Mental Health Clinical Research Center for the Study of Suicidal Behavior, Laboratories of Neuropharmacology, Western Psychiatric Institute and Clinic, Biomedical Science Tower, Room W-1644, University of Pittsburgh, School of Medicine, 3811 O'Hara St, Pittsburgh, PA 15213 (Dr Mann).

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References
APPI Online CME 2007;2007:2-2.
FULL TEXT  

Suicide Prevention Strategies: A Systematic Review
Mann et al.
JAMA 2005;294:2064-2074.
ABSTRACT | FULL TEXT  

Suicide risk: structured professional judgement
Bouch and Marshall
Adv. Psychiatr. Treat. 2005;11:84-91.
ABSTRACT | FULL TEXT  

The Relationship Between Antidepressant Medication Use and Rate of Suicide
Gibbons et al.
Arch Gen Psychiatry 2005;62:165-172.
ABSTRACT | FULL TEXT  

Relationship Between Antidepressant Medication Treatment and Suicide in Adolescents
Olfson et al.
Arch Gen Psychiatry 2003;60:978-982.
ABSTRACT | FULL TEXT  

Adolescent Depression
Brent and Birmaher
NEJM 2002;347:667-671.
FULL TEXT  

A Current Perspective of Suicide and Attempted Suicide
Mann
ANN INTERN MED 2002;136:302-311.
ABSTRACT | FULL TEXT  

A Systematic Review of Newer Pharmacotherapies for Depression in Adults: Evidence Report Summary: Clinical Guideline, Part 2
Williams et al.
ANN INTERN MED 2000;132:743-756.
ABSTRACT | FULL TEXT  

Fluoxetine in the Treatment of Premenstrual Dysphoria
Steiner et al.
NEJM 1995;332:1529-1534.
ABSTRACT | FULL TEXT  

Clinical Practice Guidelines for Depression in Primary Care: What Social Workers Need to Know
Littrell
Research on Social Work Practice 1995;5:131-151.
ABSTRACT  

Antidepressants and suicide
Jick et al.
BMJ 1995;310:215-218.
ABSTRACT | FULL TEXT  

Relative mortality from overdose of antidepressants
Henry et al.
BMJ 1995;310:221-224.
ABSTRACT | FULL TEXT  

The Toxicity and Dose of Desipramine Hydrochloride
Amitai and Frischer
JAMA 1994;272:1719-1720.
ABSTRACT  

Choice of antidepressants: questionnaire survey of psychiatrists and general practitioners in two areas of Sweden
Isacsson et al.
BMJ 1994;309:1546-1549.
ABSTRACT | FULL TEXT  

Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide
Freemantle et al.
BMJ 1994;309:249-253.
ABSTRACT | FULL TEXT  

SUICIDE AND ANTIDEPRESSANTS: INCREASED RISK WITH TRICYCLICS
JWatch General 1993;1993:1-1.
FULL TEXT