Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study  

Oleh:

Rubino, Annalisa ; Roskelt, Neil ; Tennis, Pat ; Mines, Daniel ; Weich, Scott ; Andrews, Elizabeth

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: British Medical Journal (keterangan: ada di Proquest) vol. 334 no. 7587 (Feb. 2007), page 242.

Ketersediaan

Perpustakaan FK Nomor Panggil: B16.K.2007.04 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

Lihat Detail Induk

Isi artikel

ABSTRACT Objective To compare the risk of suicide in adults using the antidepressant venlafaxine with the risk of suicide in adult using citalopram, fluoxetine, and dothiepin. Design Retrospective cohort study. Setting UK General Practice Research Database. Participants 219088 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, including previous 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 forvenlafaxine 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 forvenlafaxine 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. "'.. venlafaxine differs from that in patients prescribed other antidepressants.23 We selected the selective sero¬tonin reuptake inhibitor citalopram as a comparator. As citalopram and venlafaxine were introduced in the same year in the United Kingdom, we assumed that doctors would preferentially prescribe either drug to patients who were unresponsive to previous therapies4 and presumably had similar risks of suicide. Additional study comparators were fluoxetine and dothiepin. METHODS We selected patients with an incident prescription (first ever prescription recorded) for venlafaxine, cita¬lopram, fluoxetine, or dothiepin during 1995 to 2005. Patients had to be aged 18 to 89 years at the time of incident prescription for any study drug, and have a record of depression or anxiety. Patients were followed from their incident prescrip¬tion date until the earliest of completed suicide or first attempted suicide, the end of the study period, or the end of their record. We censored follow-up time dur¬ing periods of no use of any study drug. Outcome measures and exposure to study drugs Our end points were completed suicide (see definition on bmj.com) and the first attempted suicide during the study period, including completed suicides. For the completed suicide analysis we included patients who attempted suicide during the study period (see bmj.com). We assumed that exposure to any study drug began on the day after the prescription date and extended to 14 days after the imputed end of the prescription, based on number of pills supplied and dosing instruc¬tions.

Opini Anda

Klik untuk menuliskan opini Anda tentang koleksi ini!

Kembali