Abstract
A principal issue in pharmacoepidemiology is to estimate the impact of drugs on suicide risk in view of numerous methodological limitations. Owing to methodological concerns or differences, the findings of studies are often conflicting so it is difficult to draw conclusions about the suicide risk associated with drugs. An additional challenge in personalised suicidology is to identify characteristics of patients whose risk of suicide is increased when they are exposed to specific drugs. In this review, we investigate the impact of drugs on suicide risk in specific populations and the characteristics associated with an increased risk for the various therapeutic classes on the basis of the available data. Suicidal behaviours are linked to at least 58 different approved prescription drugs. The main mentioned classes are antidepressants, anticonvulsants and smoking cessation drugs. Antidepressants, anticonvulsants and sedative medications have been associated with suicidal behaviour in specific contexts. However, these associations remain to be proven and their mechanisms elucidated.
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Ahearn EP, Chen P, Hertzberg M et al (2013) Suicide attempts in veterans with bipolar disorder during treatment with lithium, divalproex, and atypical antipsychotics. J Affect Disord 145:77–82
Arana A, Wentworth CE, Ayuso-Mateos JL, Arellano FM (2010) Suicide-related events in patients treated with antiepileptic drugs. NEJM 363:542–551
Ayuso-Mateos JL, Baca-Garcia E, Bobes J et al (2012) Recommendations for the prevention and management of suicidal behaviour. Rev Psiquiatr Salud Ment 5:8–23
Brent DA, Emslie GJ, Clarke GN, Asarnow J, Spirito A, Ritz L et al (2009) Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. Am J Psychiatry 166:418–426
Carlsten A, Waern M (2009) Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly? BMC Geriatr 9:20
Carvalho AF, Dimellis D, Gonda X, Vieta E, McLntyre RS, Fountoulakis KN (2014) Rapid cycling in bipolar disorder: a systematic review. J Clin Psychiatry 75:e578–e586
Chen Q, Sjolander A, Runeson B, D’Onofrio BM, Lichtenstein P, Larsson H (2014) Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study. BMJ 348:g3769
Christensen J, Vestergaard M, Mortensen PB, Sidenius P, Agerbo E (2007) Epilepsy and risk of suicide: a population-based case-control study. Lancet Neurol 6:693–698
Cooper WO, Callahan ST, Shintani A et al (2014) Antidepressants and suicide attempts in children. Pediatrics 133:204–210
Darke S, Ross J, Lynskey M, Teesson M (2004) Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence and risk factors. Drug Alcohol Depend 73:1–10
Gibbons RD, Mann JJ (2011) Strategies for quantifying the relationship between medications and suicidal behaviour: what has been learned? Drug Saf 34:375–395
Gibbons RD, Mann JJ (2013) Varenicline, smoking cessation, and neuropsychiatric adverse events. Am J Psychiatry 170:1460–1467
Gibbons RD, Brown CH, Hur K, Davis J, Mann JJ (2012) Suicidal thoughts and behavior with antidepressant treatment: reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry 69:580–587
Gibbons RD, Coca Perraillon M, Hur K, Conti RM, Valuck RJ, Brent DA (2015) Antidepressant treatment and suicide attempts and self-inflicted injury in children and adolescents. Pharmacoepidemiol Drug Saf 24:208–214
Hawton K, Casanas ICC, Haw C, Saunders K (2013) Risk factors for suicide in individuals with depression: a systematic review. J Affect Disord 147:17–28
Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN (2012) Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev 11:CD004851
Isacsson G, Rich CL (2014) Antidepressant drugs and the risk of suicide in children and adolescents. Pediatr Drugs 16:115–122
Leon AC, Demirtas H, Li C, Hedeker D (2012) Two propensity score-based strategies for a three-decade observational study: investigating psychotropic medications and suicide risk. Stat Med 31:3255–3260
Maloney E, Degenhardt L, Darke S, Mattick RP, Nelson E (2007) Suicidal behaviour and associated risk factors among opioid-dependent individuals: a case-control study. Addiction 102:1933–1941
Miller M, Pate V, Swanson SA et al (2014a) Antidepressant class, age, and the risk of deliberate self-harm: a propensity score matched cohort study of SSRI and SNRI users in the USA. CNS Drugs 28:79–88
Miller M, Swanson SA, Azrael D, Pate V, Sturmer T (2014b) Antidepressant dose, age, and the risk of deliberate self-harm. JAMA Intern Med 174:899–909
Moore TJ, Furberg CD, Glenmullen J, Maltsberger JT, Singh S (2011) Suicidal behavior and depression in smoking cessation treatments. PLoS One 6:e27016
Mula M, Sander JW (2013) Suicide risk in people with epilepsy taking antiepileptic drugs. Bipolar Disord 15:622–627
Mula M, Kanner AM, Schmitz B, Schachter S (2013) Antiepileptic drugs and suicidality: an expert consensus statement from the task force on therapeutic strategies of the ILAE commission on neuropsychobiology. Epilepsia 54:199–203
Pugh MJ, Copeland LA, Zeber JE et al (2012) Antiepileptic drug monotherapy exposure and suicide-related behavior in older veterans. J Am Geriatr Soc 60:2042–2047
Pugh MJ, Hesdorffer D, Wang CP, Amuan ME, Tabares JV, Finley EP et al (2013) Temporal trends in new exposure to antiepileptic drug monotherapy and suicide-related behavior. Neurology 81:1900–1906
Raja M, Azzoni A, Koukopoulos AE (2009) Psychopharmacological treatment before suicide attempt among patients admitted to a psychiatric intensive care unit. J Affect Disord 113:37–44
Rihmer Z, Gonda X (2013) Pharmacological prevention of suicide in patients with major mood disorders. Neurosci Biobehav Rev 37:2398–2403
Ringback Weitoft G, Berglund M, Lindstrom EA, Nilsson M, Salmi P, Rosen M (2014) Mortality, attempted suicide, re-hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden-a register-based study. Pharmacoepidemiol Drug Saf 23:290–298
Stone M, Laughren T, Jones ML, Levenson M, Holland PC, Hughes A et al (2009) Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 339:b2880
Thomas KH, Martin RM, Davies NM, Metcalfe C, Windmeijer F, Gunnell D (2013) Smoking cessation treatment and risk of depression, suicide, and self harm in the Clinical Practice Research Datalink: prospective cohort study. BMJ 347:f5704
Thomas KH, Martin RM, Potokar J, Pirmohamed M, Gunnell D (2014) Reporting of drug induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011. BMC Pharmacol Toxicol 15:54
Tiihonen J, Suokas JT, Suvisaari JM, Haukka J, Korhonen P (2012) Polypharmacy with antipsychotics, antidepressants, or benzodiazepines and mortality in schizophrenia. Arch Gen Psychiatry 69:476–483
Valenstein M, Kim HM, Ganoczy D et al (2009) Higher-risk periods for suicide among VA patients receiving depression treatment: prioritizing suicide prevention efforts. J Affect Disord 112:50–58
VanCott AC, Cramer JA, Copeland LA, Zeber JE, Steinman MA, Dersh JJ et al (2010) Suicide-related behaviors in older patients with new anti-epileptic drug use: data from the VA hospital system. BMC Med 8:4
Wasserman D, Rihmer Z, Rujescu D et al (2012) The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. Eur Psychiatry 27:129–141
Wines JD Jr, Saitz R, Horton NJ, Lloyd-Travaglini C, Samet JH (2004) Suicidal behavior, drug use and depressive symptoms after detoxification: a 2-year prospective study. Drug Alcohol Depend 76:S21–S29
Yerevanian BI, Choi YM (2013) Impact of psychotropic drugs on suicide and suicidal behaviors. Bipolar Disord 15:594–621
Youssef NA, Rich CL (2008) Does acute treatment with sedatives/hypnotics for anxiety in depressed patients affect suicide risk? A literature review. Ann Clin Psychiatry 20:157–169
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Tournier, M. (2016). A Need for Personalised Suicidology: Pharmacoepidemiology. In: Courtet, P. (eds) Understanding Suicide. Springer, Cham. https://doi.org/10.1007/978-3-319-26282-6_32
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DOI: https://doi.org/10.1007/978-3-319-26282-6_32
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