• Online Features  This Article  • Full text  • PDF  • eTables and eFigures  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (8)  • Contact me when this article is cited  Related Content  • Readers Reply  • Similar articles in this journal  Topic Collections  • Pediatrics  • Adolescent Medicine  • Psychiatry  • Adolescent Psychiatry  • Depression  • Psychopharmacology  • Suicide  • Quality of Care  • Patient Safety/ Medical Error  • Drug Therapy  • Adverse Effects  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

A Propensity Score–Adjusted Analysis of 9 Years' Data

Sebastian Schneeweiss, MD, ScD; Amanda R. Patrick, MS; Daniel H. Solomon, MD, MPH; Jyotsna Mehta, MS; Colin Dormuth, MA, MS, ScD; Matthew Miller, MD, ScD; Jennifer C. Lee, BS; Philip S. Wang, MD, DrPH

Arch Gen Psychiatry. 2010;67(5):497-506.

Context  A US Food and Drug Administration advisory has warned that antidepressants may be associated with an increased risk of suicidal thoughts and behaviors in adolescents. This prompted a meta-analysis of trials in adults that found no overall increase in risk, but individual agents could not be studied.

Objective  To assess the risk of suicide and suicide attempts associated with individual antidepressant agents.

Design  Cohort study of incident users of antidepressant agents.

Setting  Population-based health care utilization data of all residents of British Columbia, Canada, aged 18 years and older between January 1, 1997, and December 31, 2005.

Patients  British Columbia residents who had antidepressant therapy initiated and had a recorded diagnosis of depression.

Intervention  Initiation of various antidepressant medications.

Main Outcome Measures  Combined suicide death or hospitalization due to self-harm.

Results  In a population of 287 543 adults aged 18 years and older with antidepressant therapy initiated, we observed outcome rates ranging from 4.41/1000 person-years to 9.09/1000 person-years. Most events occurred in the first 6 months after treatment initiation. After extensive propensity score adjustment, we found no clinically meaningful variation in the risk of suicide and suicide attempt between antidepressant agents compared with fluoxetine hydrochloride initiation: citalopram hydrobromide, hazard ratio = 1.00 (95% confidence interval, 0.63-1.57); fluvoxamine maleate, hazard ratio = 0.98 (95% confidence interval, 0.63-1.51); paroxetine hydrochloride, hazard ratio = 1.02 (95% confidence interval, 0.77-1.35); and sertraline hydrochloride, hazard ratio = 0.75 (95% confidence interval, 0.53-1.05). Compared with selective serotonin reuptake inhibitors as a drug class, other classes including serotonin-norepinephrine reuptake inhibitors, tricyclic agents, and other newer and atypical agents had a similar risk. Restriction to patients with no antidepressant use in the past 3 years further reduced apparent differences between groups.

Conclusions  Our finding of equal event rates across antidepressant agents supports the US Food and Drug Administration's decision to treat all antidepressants alike in their advisory. Treatment decisions should be based on efficacy, and clinicians should be vigilant in monitoring after initiating therapy with any antidepressant agent.

Author Affiliations: Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School (Drs Schneeweiss, Solomon, and Wang and Mss Patrick, Mehta, and Lee) and Harvard Injury Control Research Center, Department of Health Policy and Management, Harvard School of Public Health (Dr Miller), Boston, Massachusetts; Therapeutics Initiative, Department of Anesthesia, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada (Dr Dormuth); and National Institute of Mental Health, Bethesda, Maryland (Dr Miller).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Propensity Score-based Sensitivity Analysis Method for Uncontrolled Confounding
Li et al.
Am J Epidemiol 2011;174:345-353.
ABSTRACT | FULL TEXT  

Covariate Selection in High-Dimensional Propensity Score Analyses of Treatment Effects in Small Samples
Rassen et al.
Am J Epidemiol 2011;173:1404-1413.
ABSTRACT | FULL TEXT  

RAPID RESPONSES TO THIS ARTICLE

VARIATION IN THE RISK OF SUICIDE BY ANTIDEPRESSANT AGENT IN ADULTS
John R. Geddes
Arch Gen Psychiatry Online, 22 Jul 2010.
TEXT 

Suicide Causality
Donald F. Klein
Arch Gen Psychiatry Online, 16 Aug 2010.
TEXT