Risk of suicide during treatment with venlafaxine, italopram, fluoxetine, and dothiepin : retrospective cohort study
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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Official URL: http://dx.doi.org/10.1136/bmj.39041.445104.BE
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
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
|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|
|Official Date:||12 December 2006|
|Access rights to Published version:||Open Access|
|Funder:||Wyeth Pharmaceutical Company|
1 Committee for the Safety of Medicine (CSM) expert workingg roup on the safety of
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