Antidepressants and suicidal behavior: cause or cure?

摘要

Observational studies of treatment can provide additional clues about the relationship between treatment and suicidal behavior, although the results have been contradictory (3,4). Simon and Savarino provide an elegant illustration of the need to consider the previous history of suicidal behavior and its role in referral when evaluating the relationship between treatment and subsequent suicidal behavior. They examined a large database of outpatient claims from a prepaid health plan and compared the rate of suicide attempts in the 90 days before and the 180 days after initiation of antidepressant or psychotherapy treatment. The peak period of attempts was in the month before the initiation of treatment, regardless of the setting or type of treatment. The authors interpret these findings to mean that a suicide attempt was a common precipitant for referral to treatment and that the decline in suicide attempts after treatment initiation was due to nonspecific therapeutic factors.