21% of suicide autopsies find antidepressants present!
Autopsy finds antidepressants in 21% of suicides. (Psychiatry)
BROOMFIELD, COLO. — Eleven percent of 123 youth suicide completers and 21% of 2,674 adults who died by suicide tested positive for the presence of an antidepressant in a comprehensive multistate study, Catherine Barber said at the annual conference of the American Association of Suicidology.
These rather modest rates “do not sound the alarm” about the safety of antidepressants, despite the Food and Drug Administration’s call for a black box warning saying that antidepressants increase the risk of suicidal thinking and behavior in children and adolescents, said Ms. Barber of the Injury Control Research Center at Harvard School of Public Health, Boston.
She reported on 4,004 completed suicides for which detailed data were collected in the Harvard-based pilot project that led to creation of the Centers for Disease Control and Prevention’s new National Violent Death Reporting System. (See story on p. 14.) Those deaths constituted all confirmed suicides occurring within a handful of participating states and urban counties in 2001 and 2002.
Overall, 70% of all suicide completers–and 75% of those under age 18–underwent toxicologic testing for substances including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and atypical antidepressants. Few laboratories tested for MAO inhibitors; however, they are seldom prescribed anymore.
Of note, the SSRIs did not lead the list of antidepressants for which suicide completers tested positive (see box), although that is the drug class on which the controversy has focused to date.
A particularly interesting finding in this pilot study was that a positive blood test for antidepressants was found in 54% of suicide completers who carried a diagnosis of depression for which they were in current treatment at the time of their death. That’s an unexpectedly low rate for which there are only three possible explanations: Either the sensitivity of toxicology tests is low; lots of patients who committed suicide were receiving psychotherapy but no medication; or patients were slipping through the cracks.
That is, a problem might exist with patient compliance and provider case management. Ms. Barber suspects the answer lies in this latter possibility.
“The fact that only half of victims of all ages who were in current treatment and diagnosed with depression tested positive for antidepressants does raise a red flag about the need to improve case management,” she said.
Funding for her study was provided by foundations including the John D. and Catherine T. MacArthur Foundation, the David and Lucille Packard Foundations, and the Open Society Institute.
ARTICLES BY BRUCE JANCIN
Denver Bureau
Suicide Completers Testing Positive for Antidepressant
Tricyclics 21%
Amitriptyline 26
Nortriptyline 20
Doxepin 10
Clomipramine 2
Desipramine 2
Imipramine 1
Protriptyline 1
Atypicals 44%
Venlafaxine 41
Buproprion 36
Mirtazapine 27
Trazodone 23
Nefazodone 1
SSRIs 35%
Citalopram 44
Sertraline 25
Fluoxetine 16
Paroxetine 12
Fluvoxamine 5
n=292
Source: Ms. Barber
Note: Table made from pie chart.
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