The Corpus Callosum

Antidepressant-Suicide Risk Update

i-ded70df884c37dea8fee49dc0d21e3c1-fluoxetine structure.JPGThis
controversy has been evolving for the past three years.
 Perhaps at this point it is no longer newsworthy.
 But often, after a topic fades from the radar of the MSM,
there are new findings.

The journal, Psychological Medicine, has published
a study about the risk of suicidal thinking and behavior in persons
treated with an antidepressant ()
for conditions other than depression.  

suicide-related adverse events in clinical trials of fluoxetine
treatment in adults for indications other than major depressive disorder

Published online by Cambridge University Press 20 Jul 2007

Background The
association between treatment-emergent suicidality as an adverse event
and fluoxetine treatment was examined using a fluoxetine double-blind
placebo-controlled database of clinical trials for indications other
than major depressive disorder.

Method The database consisted of 53 trials for 16
different indications (14 psychiatric, two non-psychiatric). Within
each study, patient adverse event reports and narratives were searched
extensively for treatment-emergent thoughts and behaviors associated
with suicide. The incidence of adverse events was classified using Food
and Drug Administration (FDA) codes for completed suicide, preparatory
acts, suicidal ideation and the summary category of ‘all
suicidality.’ The risk difference and risk ratios between
fluoxetine and placebo treatment arms were compared using
Mantel–Haenszel methods.

Results Within this large database, patients were
randomly assigned to receive treatment with either fluoxetine (n=7066)
or placebo (n=4382). Treatment groups did not differ in their risk for
the emergence of suicidality for any FDA code; the risk ratio for
‘all suicidality’ was 0·82
(p=0·406), and there were no completed suicides in either
group. Analyses based on treatment indication (bulimia,
obsessive-compulsive disorder, other psychiatric and non-psychiatric
illness) also showed no significant difference in risk between
treatment groups. When examined by age categories (18–24,
25–30, 31–65, and 65+ years), fluoxetine and
placebo treatments did not result in significant risk difference for
the emergence of suicidality.

Conclusions The risk of treatment-emergent
suicidality does not appear to be associated with fluoxetine treatment
for adults with various non-MDD conditions.

So a sample of 11,448 persons (7,066 treated; others on placebo) shows
no increased risk, when the patients were treated for something other
than depression.  

The caveat is that the study was funded by Eli Lilly, the makers of the
name-brand form of fluoxetine.  This in itself tells you
nothing about the veracity of the study, but it does mean that we need
to see what independent researchers make of it over time.


  1. #1 "GrrlScientist"
    August 25, 2007

    what is “something other than depression”? obsessive-compulsive disorder? bulimia? how common is it to use prozac for these disorders?

  2. #2 llewelly
    August 25, 2007

    I seem to recall fluoxetine is sometimes prescribed for social phobia.

  3. #3 Joseph j7uy5
    August 25, 2007

    Pretty much all anxiety disorders: panic disorder, social phobia, obsessive-compulsive disorder, generalized anxiety disorder, posttraumatic stress disorder, can be treated with SSRIs. The exceptions are simple phobias and agoraphobia without panic.

    Bulimia is another disorder that is treated with SSRIs.

    Such use is quite common, although I cannot give any precise figures. The number of patients is in the millions, I suspect.

  4. #4 Dirkh
    August 27, 2007

    “Treatment-emergent suicidality” is one tricky call in a cohort of patients suffering from depression and often some degree of suicidal ideation to begin with, but clearly this research needs to continue. Correct me if I’m wrong, but it seems to me most of the studies since the big British teen scare have been relatively benign with respect to the suicide question. Unfortunately, from the general public’s point of view, I’m afraid this isn’t easily distinguished from Scientology’s earlier “Prozac Kills” campaign.

  5. #5 Dirkh
    August 28, 2007

    “Bulimia is another disorder that is treated with SSRIs.”

    Also severe PMS, and carbohydrate-craving obesity in some cases. (Remember phen-fen? Not technically an SSRI but sort of like half-Prozac.)

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