Rubino, Annalisa, Roskell, Neil, Tennis, Pat, Mines, Daniel, Weich, Scott and Andrews, Elizabeth. (2006) Risk of suicide during treatment with venlafaxine, italopram, fluoxetine, and dothiepin : retrospective cohort study. BMJ, Vol.334 (No.7587). ISSN 0959-535X

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Abstract

Objective To compare the risk of suicide in adults usingthe antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin. Design Retrospective cohort study. Setting UK General Practice Research Database. Participants 219 088 patients, aged 18-89 years, who were prescribed venlafaxine, citalopram, fluoxetine, or dothiepin from 1995 to 2005. Main outcome measures Completed suicide and attempted suicide. Results Venlafaxine users had a higher burden of risk factors for suicide, includingprevious suicide attempts and proxies for severe depression or depression that was difficult to treat. In the analysis for completed suicides, unadjusted and adjusted hazard ratios for venlafaxine compared with citalopram were 2.44 (95% confidence interval 1.12 to 5.31) and 1.70 (0.76 to 3.80), for venlafaxine compared with fluoxetine were 2.85 (1.37 to 5.94) and 1.63 (0.74 to 3.59), and for venlafaxine compared with dothiepin were 2.54 (1.07 to 6.02) and 1.31 (0.53 to 3.25). Compared with other study drugs, venlafaxine was also associated with an increased risk of attempted suicide, but adjustment for measured confounders substantially reduced the hazard ratios. Conclusions Venlafaxine use was consistently associated with higher risk of suicide compared with citalopram, fluoxetine, and dothiepin. Venlafaxine users had a higher burden of suicide risk factors, however, and adjustment for measured confounders substantially reduced the excess risks. Since the secondary data used in this analysis allowed only indirect and partial measurements of potential confounders, it is possible that residual confounding explains much, if not all, of the observed excess risk.

Item Type:	Journal Article
Subjects:	R Medicine > RM Therapeutics. Pharmacology R Medicine > RS Pharmacy and materia medica
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Suicidal behavior, Side effects -- Drugs, Venlafaxine, Antidepressants
Journal or Publication Title:	BMJ
Publisher:	BMJ Group
ISSN:	0959-535X
Date:	12 December 2006
Volume:	Vol.334
Number:	No.7587
Identification Number:	10.1136/bmj.39041.445104.BE
Status:	Peer Reviewed
Access rights to Published version:	Open Access
Funder:	Wyeth Pharmaceutical Company
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URI:	http://wrap.warwick.ac.uk/id/eprint/252

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