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Abstract

It is generally accepted that the risk of fatality after overdose with tricyclic antidepressants (TCAs) is greater than after overdose with nontricyclic antidepressants (particularly selective serotonin reuptake inhibitors [SSRIs]). This has provided one of the most powerful arguments for the use of SSRIs in preference to TCAs in depressed patients.

In England and Wales, however, overdose involving antidepressants accounts for the minority (6%) of suicides, the majority being a result of a violent method (38%), overdose or ingestion of any toxic substance other than an antidepressant (25%), or gassing, mostly by carbon monoxide inhalation from motor vehicle exhausts (18%).

Using the General Practice Research Database (GPRD), it has been possible to estimate the proportion of all-method suicides which occur following the prescription of TCAs or an SSRI. After adjustment for confounding factors, the overall occurrence of suicide by any method was not statistically significantly different between patients treated with either group of drugs. Thus, replacement of TCAs by SSRIs as a strategy to reduce the overall suicide rate is unlikely to succeed.

Keywords

Suicide Overdose Antidepressants Depression

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The Use of the General Practice Research Database (Gprd) to Examine Potential Links between Antidepressant Medication and the Incidence of Suicide

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