Antidepressants and suicide
http://www.100md.com
《英国医生杂志》
EDITOR—We agree with Aldred and Healy's suggestion that part of the recent rise in antidepressant prescribing may be due to there being a growing number of long term users of these drugs—we acknowledged this as a limitation of our model. If any adverse effects of antidepressants on suicide risk occur mainly in the first few weeks of treatment then our model will overestimate these.
Mitchell correctly identifies that one of the major assumptions we made in our model was that the risk estimates of non-fatal suicidal behaviour derived from paediatric trials could be applied to fatal suicidal behaviour in adults. We acknowledged this important limitation of our modelled "worst case scenario" in the paper. Mitchell points out the drug specific risk estimates we reported in the table are risk ratios rather than odds ratios. The odds ratios for the drug specific estimates are very similar to the relative risks. Mitchell may have misunderstood one aspect of our model by suggesting it estimates the excess of non-fatal suicidal acts. We derived our estimates from prescribing data, the suicide rate among patients receiving antidepressants in primary care,1 and we assumed (see above) that the relative risk of non-fatal suicidal behaviour in paediatric trials of selective serotonin reuptake inhibitors (SSRIs) is similar for suicide and all ages. If we had wished to estimate effects on non-fatal self-harm we would have used the rate among people receiving antidepressants rather than the suicide rate; as rates of non-fatal self harm are over 20 times higher than those for suicide this would result in a higher estimate.
David Gunnell, professor of epidemiology
D.J.Gunnell@bristol.ac.uk Department of Social Medicine, University of Bristol, Bristol BS8 2PR
Deborah Ashby, professor of medical statistics
Wolfson Institute of Preventive Medicine, Barts and London, Queen Mary School of Medicine and Dentistry, University of London, London EC1M 6BQ
Competing interests: DG and DA are members of the Medical and Healthcare Products Regulatory Agency's expert working group on the safety of SSRIs, and DA is a member of the Committee on Safety of Medicines. Both act as independent advisers, receiving travel expenses and a small fee for attending meetings and reading materials in preparation for the meeting. DA has spoken on the methods of adverse drugs reactions in HIV at a scientific meeting attended by several pharmaceutical companies, and sponsored by GlaxoSmithKline. An honorarium was paid to her department.
References
Jick HSS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995;310: 215-8.
Mitchell correctly identifies that one of the major assumptions we made in our model was that the risk estimates of non-fatal suicidal behaviour derived from paediatric trials could be applied to fatal suicidal behaviour in adults. We acknowledged this important limitation of our modelled "worst case scenario" in the paper. Mitchell points out the drug specific risk estimates we reported in the table are risk ratios rather than odds ratios. The odds ratios for the drug specific estimates are very similar to the relative risks. Mitchell may have misunderstood one aspect of our model by suggesting it estimates the excess of non-fatal suicidal acts. We derived our estimates from prescribing data, the suicide rate among patients receiving antidepressants in primary care,1 and we assumed (see above) that the relative risk of non-fatal suicidal behaviour in paediatric trials of selective serotonin reuptake inhibitors (SSRIs) is similar for suicide and all ages. If we had wished to estimate effects on non-fatal self-harm we would have used the rate among people receiving antidepressants rather than the suicide rate; as rates of non-fatal self harm are over 20 times higher than those for suicide this would result in a higher estimate.
David Gunnell, professor of epidemiology
D.J.Gunnell@bristol.ac.uk Department of Social Medicine, University of Bristol, Bristol BS8 2PR
Deborah Ashby, professor of medical statistics
Wolfson Institute of Preventive Medicine, Barts and London, Queen Mary School of Medicine and Dentistry, University of London, London EC1M 6BQ
Competing interests: DG and DA are members of the Medical and Healthcare Products Regulatory Agency's expert working group on the safety of SSRIs, and DA is a member of the Committee on Safety of Medicines. Both act as independent advisers, receiving travel expenses and a small fee for attending meetings and reading materials in preparation for the meeting. DA has spoken on the methods of adverse drugs reactions in HIV at a scientific meeting attended by several pharmaceutical companies, and sponsored by GlaxoSmithKline. An honorarium was paid to her department.
References
Jick HSS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995;310: 215-8.