Antidepressant study may allay suicide risk fears: looking at patients both before and after treatment reveals risk drops 60% in first month of medication.(Clinical Rounds)

Psychiatrists say a new study should help convince the public that newer antidepressants do not appear to be associated with a high risk of suicide.

In the study of about 60,000 enrollees at Group Health Cooperative (GHC), a nonprofit health care system based in Seattle, the risk of suicide decreased by 60% in the first month after treatment began and continued to decline in the following 5 months of the study (Am. J. Psychiatry 2006;163:41-7). The risk of suicide was highest in the month before treatment.

Looking at patients both before and after treatment gives a clearer look at the whole picture, said Dr. Greg Simon, the study's lead investigator, who noted that no other study has examined suicide risk before a patient began treatment.

"If you didn't look at the months before treatment, the risk after treatment would look very high," Dr. Simon said in an interview.

He said the study seems to debunk the idea that starting a medication somehow activates a depressed person and leads him or her to act out suicidal behaviors more aggressively than before treatment.

"The idea that there's something especially risky about the time people start taking medications--that's not true" given the study results, but more studies are needed to definitively answer the question, he said.

Dr. Darrel A. Regier, director of the American Psychiatric Association's research division, said one of the study's strengths was its examination of patients before medication started. And because it was observational, it included people with more severe mental disorders, who are normally excluded from randomized trials, he said.