Antidepressants reduce the risk of suicide among elderly depressed patients

Treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of impulsive acts including suicide, while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial. We aimed to evaluate the association between exposure to antidepressants and suicidality in a cohort of elderly patients suffering from major depressive disorder (MDD). This was a retrospective matched case-controlled evaluation over a 10-year period. All records of admissions of patients with MDD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The case-controlled group was the next admission of a patient suffering from MDD, matched for sex and age who had not attempted suicide in the month prior to admission. The index group during the 10-year period (1995-2004) consisted of 101 patients suffering from MDD who were hospitalized following a suicide attempt. Mean age for the group was 76.5 ± 6.6 years; there were 42 men and 59 women. The control group patients (N = 101) were matched for age (mean 76.6 ± 6.9 years) and sex. The proportion of patients exposed to an antidepressant was significantly greater in the control group, than in the group of patients who had attempted suicide (58 vs 42%, odds ratio 1.94 (95% CI: 1.1-3.4), p = 0.019). SSRIs were prescribed in 29% of patients in the control group vs 21% of patients in the index group (p = 0.03). It is of interest to note that concomitant prescription of benzodiazepines also conferred a protective effect. In conclusion, elderly depressed patients treated with antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.