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Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above.

Journal article
Authors Khedidja Hedna
Karolina Andersson Sundell
Armina Hamidi
Ingmar Skoog
Sara Gustavsson
Margda Waern
Published in European journal of clinical pharmacology
ISSN 1432-1041
Publication year 2017
Published at Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry
Institute of Medicine, Department of Public Health and Community Medicine
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Language en
Links dx.doi.org/10.1007/s00228-017-2360-...
www.ncbi.nlm.nih.gov/entrez/query.f...
https://gup-server.ub.gu.se/v1/asse...
Subject categories Health Sciences

Abstract

To investigate associations between antidepressant use patterns and risk of fatal and non-fatal suicidal behaviours in older adults who initiated antidepressant therapy.A 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.During 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).Switching 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.

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