Risk of suicide during treatment with venlafaxine, citalopram, fluoxetine, and dothiepin: retrospective cohort study.

摘要: Objective To compare the risk of suicide in adults using antidepressant venlafaxine compared with citalopram, fluoxetine, and dothiepin. Design Retrospective cohort study. Setting UK General Practice Research Database. Participants 219 088 patients, aged 18-89 years, who were prescribed venlafaxine, or dothiepin from 1995 to 2005. Main outcome measures Completed attempted suicide. Results Venlafaxine users had a higher burden factors for suicide, including previous attempts proxies severe depression that was difficult treat. In analysis completed suicides, unadjusted adjusted hazard ratios citalopram 2.44 (95% confidence interval 1.12 5.31) 1.70 (0.76 3.80), fluoxetine 2.85 (1.37 5.94) 1.63 (0.74 3.59), 2.54 (1.07 6.02) 1.31 (0.53 3.25). Compared other study drugs, also associated an increased but adjustment measured confounders substantially reduced ratios. Conclusions use consistently dothiepin. factors, however, excess risks. Since secondary data used this allowed only indirect partial measurements potential confounders, it is possible residual confounding explains much, if not all, observed risk.