APA: SSRIs More Likely in Suicides than in Other Young Deaths

SAN DIEGO, May 25 -- Young suicide victims were significantly more likely to have SSRIs in their bloodstream than were young homicide or accident victims, investigators reported here.

In an analysis of "unnatural" deaths recorded by the Virginia Medical Examiner's Office for 1987 through 2003, Antony Fernandez, M.D., and colleagues, found that selective serotonin reuptake inhibitors or the serotonin-norepinephrine reuptake inhibitor venlafaxine appeared significantly more often in post-mortem toxicology of suicides than of accident or murder victims.

Among the children who committed suicide, SSRIs/venlafaxine were not found more often among those whose deaths were ruled suicide by poison than among those who hung or shot themselves, the researchers noted at the American Psychiatric Association meeting.

But the investigators, from the Virginia Commonwealth University in Richmond and the University of Virginia in Roanoke-Salem, cautioned that their data are descriptive only, and do not establish a causal link between the antidepressants and suicide.

"Finding antidepressants in the 'suicide by poisoning' group may mean any of the following: (1) youths committing suicide received antidepressants for depression; (2) youths committing suicide do so before the antidepressant drugs became effective; (3) antidepressant drugs were 'activating' and this led to suicide; and (4) antidepressant drugs induced suicidal behaviors by other means."

They noted that the hypotheses are not mutually exclusive.

The authors analyzed a total of 2,818 unnatural deaths in children and adolescents, grouped as either from accidents, homicide, or suicide. Of this group, toxicology results were available for 753 cases, of which 732 were either African American or White youths.

They found that:

• For all unexpected deaths from any cause, antidepressants were found more commonly among whites than among blacks.
• Suicide by poisoning occurred more commonly among whites.
• Recreational drugs were found more commonly among blacks than whites.
• White female youths were more likely to die by suicide than black females, and black males were more likely to die by homicide than white males.
• Antidepressants were found in 39 black and white suicides. There were 17 antidepressants, all tricyclics, in suicide by poisoning, and no other antidepressants were found in lethal levels among those who poisoned themselves.
• SSRIs/venlafaxine appeared more commonly in those who committed suicide (P<0.0001) than in accident or homicide victims. Among the suicides, SSRIs appeared in equal proportion among those who died from poisoning, guns or hanging. (P=0.695).

"As with adults, SSRIs are also used to treat other psychiatric illnesses in children and adolescents," the investigators wrote. "Even though both amitriptyline and doxepin are highly serotonergic tricyclic antidepressants, no tricyclic antidepressants appeared in toxicology findings for our children and adolescents who intentionally shot or hanged themselves. This finding does not support the contention that serotonergic agents provoke suicidal actions."

The authors noted that their study was limited by the retrospective design, and by a lack of information describing the mental state before death of the youths who committed suicide.

"Our retrospectively derived data do not reveal whether SSRIs are causally involved in provoking suicidal behavior or suicide. Our report does provide data that may be useful in future meta-analyses addressing this issue," they wrote.