Antidepressants and lethal violence in the Netherlands 1994-2008.

Paul F Bouvy,Marieke Liem

doi:10.1007/s00213-012-2668-2

Paul F Bouvy, Marieke Liem

Open Access

https://doi.org/10.1007/s00213-012-2668-2

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Abstract

RationaleThere is an ongoing discussion on the relation between risk of violent behaviour and the use of antidepressants. The claim that the use of antidepressants can cause violent behaviour would gain credibility if a positive association between the two could be established.ObjectiveThe objective of this study is to evaluate the relationship between homicide, suicide and homicide–suicide rates and the rates of antidepressant use by gender and age group.MethodNationwide data from the Netherlands on antidepressant prescriptions (ADs, SSRI and venlafaxine) and lethal violence were analysed over the 15-year period from 1994 to 2008.ResultsThe findings indicated a significant negative association between lethal violence (homicide and suicide) and prescription of antidepressants in the Netherlands, indicating that in a period in which the exposure of the Dutch population to antidepressants increased, rates of lethal violence decreased.ConclusionsThese data lend no support for an important role of antidepressant use in lethal violence.

Highlights

In recent years several publications have suggested a link between the use of antidepressants (ADs)— SSRIs—and lethal violence including homicide, suicide and homicide–suicide
Antidepressant treatment is wrongfully associated with such serious adverse events, these suggestions might lead to a situation in which patients with an indication for treatment with an antidepressant abstain from treatment because of fear for the possibility of these adverse events
There is an ongoing discussion on the relation between suicide risk and the use of antidepressants in children and adolescents

Summary

Introduction

In recent years several publications have suggested a link between the use of antidepressants (ADs)— SSRIs—and lethal violence including homicide, suicide and homicide–suicide. In case reports and in the lay media, it is frequently suggested that antidepressants can cause serious adverse events, including suicide and violent crime If this is true, it is important to wage the risk of these possible adverse events against the possible benefits of the treatment with antidepressants. In clinical trials with antidepressants in these groups no or very few completed suicides are reported, there appears to be an increased risk for suicidal ideation and suicidal behaviour (Hammad et al 2006; Barbui et al 2009; Stone et al 2009). In adults aged 25–64, there is a neutral effect and there seems to be a reduced risk of suicidality and suicidal behaviour in those aged over 64 (Stone et al 2009)

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