Abstract
PurposeTo investigate associations between antidepressant use patterns and risk of fatal and non-fatal suicidal behaviours in older adults who initiated antidepressant therapy.MethodA national population-based cohort study conducted among Swedish residents aged ≥ 75 years who initiated antidepressant treatment. Patients who filled antidepressant prescriptions between January 1, 2007 and December 31, 2013 (N = 185,225) were followed until December 31, 2014. Sub-hazard ratios of suicides and suicide attempts associated with use patterns of antidepressants, adjusting for potential confounders such as serious depression were calculated using the Fine and Gray regression models.ResultsDuring follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) were increased for both outcomes in those who switched to another antidepressant (aSHR for suicide 2.42, 95% confidence interval 1.65 to 3.55, and for attempt 1.76, 1.32 to 2.34). Elevated suicide risks were also observed in those who concomitantly filled anxiolytics (1.54, 1.20 to 1.96) and hypnotics (2.20, 1.69 to 2.85). Similar patterns were observed for the outcome suicide attempt. Decreased risk of attempt was observed among those with concomitant use of anti-dementia drugs (0.40, 0.27 to 0.59).ConclusionSwitching antidepressants, as well as concomitant use of anxiolytics or hypnotics, may constitute markers of increased risk of suicidal behaviours in those who initiate antidepressant treatment in very late life. Future research should consider indication biases and the clinical characteristics of patients initiating antidepressant therapy.
Highlights
IntroductionIn particular older men, tend to have the highest rates of suicide in many countries worldwide [1, 2]
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Older populations, in particular older men, tend to have the highest rates of suicide in many countries worldwide [1, 2]
We have previously presented data demonstrating that anxiolytics and hypnotics, but not antidepressants, were associated with increased suicide risk in older adults after adjustment for confounding by indication [15]
Summary
In particular older men, tend to have the highest rates of suicide in many countries worldwide [1, 2]. There is some evidence that antidepressant therapy is associated with decreased risk of suicide in late life [4, 5]. Clinical trials tend to exclude older persons often due to physical frailty [6]. This is problematic as medication use patterns, treatment response and side effects may all differ between younger and older users of antidepressants, due to higher levels of psychiatric and somatic comorbidities in the older group, as well as agerelated physiological changes [7, 8]
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