Antidepressants may curb suicides in elderly
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A study of 200 elderly individuals admitted to a psychiatric hospital in Israel found that antidepressants, including Prozac-type selective serotonin reuptake inhibitors or SSRIs, cut the risk of suicide attempts by about 50 percent.
The result appears to be the reverse of the increased risk associated with use of the same drugs in children and adolescents. Because of that risk, SSRIs for children were banned in the UK, and suicide risk warnings are now required in the US.
In a 10-year retrospective study presented today at the 158th annual meeting of the American Psychiatric Association, Dr. Yoram Barak, professor of geriatric psychiatry (Medical School of Tel-Aviv University), said treatment with benzodiazepines (sedatives) in addition to antidepressants reduced risk of attempted suicides by another 10 percent.
For the study, researchers identified 101 elderly depressed patients who had attempted suicide and were admitted to a mental health center. All of these patients were matched for age and gender to severely depressed patients admitted to the same center, but who had not attempted suicide. The mean age was 76.5, and 59 percent were female.
Based on a review of prescriptions, the group that had not attempted suicide were much more likely to be prescribed antidepressants, compared with the group that made suicide attempts. Among the antidepressants, the most frequently prescribed were SSRIs, he said.
“If you are elderly and depressed, and take an antidepressant, you have half the risk of attempting suicide,” said Barak, referring to the cases reviewed for the study. “The suicide group received much less antidepressants and much less SSRIs, and therefore they had twice the risk of suicide.”
He said, “Nobody prior to this study has directly assessed the effect of antidepressants on elderly depressed patients. The whole focus has been on children and adolescents.”
The researchers were surprised to see that exposure to benzodiazepines protected against suicide attempts. “In younger patients, they do not confer a protective effect.”
The reason why children may be at higher risk for suicide when given antidepressants, Barak speculated, could be that they may not necessarily have major depression as their primary diagnosis. Adolescents with depressive symptoms may be experiencing a traumatic reaction to a loss, rather than major depression.
In the elderly, he said, 74 percent of cases of death by suicide are associated with depression.
Following the concerns about these drugs in children and adolescents, Barak said, physicians have begun to be concerned about the potential suicide risk in the elderly who use SSRIs, because they are so widely prescribed.
He said the study was supported by a grant from Lundbeck a/s, the makers of escitalopram (Lexapro).
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Revision date: June 14, 2011
Last revised: by David A. Scott, M.D.
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