Parasuicide and psychotropic medication: Clinical data and drugs used for overdose in 202 parasuicides

We have earlier reported on medications used for overdose in 812 consecutive parasuicides. Different studies have found some kind of depression in 30–80% of parasuicides. Therefore, we then interpreted our finding that only 5% used antidepressants for overdoses as a possible indicator of underprescribing of these drugs in suicidal patients. In this study based on an extensive interview of 202 hospitalized parasuicides (69% psychiatric in-patients), we found that women used antidepressants and anxiolytics relatively more frequently for overdose (11% and 21%) than did men (3% and 8%), younger persons used more frequently analgesics (25%), and elderly more frequently hypnotics (75% in men above 75 years of age, and 57% in women above 75). Interestingly, those who took antidepressants in overdose reported lower suicide intent, while those who took anxiolytics reported more depressive symptoms. It is concluded that depressive syndromes frequently includes symptoms of anxiety and that such patients should be treated with antidepressants and not with anxiolytics alone.     

Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995-1999

OBJECTIVE: To compare the temporal changes in suicide rate among patients treated with antidepressants with the change in suicide rate among persons who have not been treated with antidepressants during 1995-1999. METHOD: In a historic prospective national pharmacoepidemiological register linkage study by using four Danish registers we included 438,625 patients who had purchased antidepressants, and compared them with 1,199,057 population based control persons. The annual rate of suicide was estimated using Poisson regression analyses. RESULTS: The suicide rate decreased for persons treated with antidepressants as well as for persons not treated with antidepressants. The proportion of persons, who committed suicide and who had not been treated with antidepressants decreased. The reduction in suicide rate was more pronounced among persons treated with SSRIs or older antidepressants than among persons not treated with antidepressants. CONCLUSION: Several factors contribute to the decreasing suicide rate. The most pronounced decrease in suicide rate was found among persons treated with antidepressants.     

Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: an analysis of the Food and Drug Administration database

The assumption that depressed patients who are assigned to placebo in antidepressant clinical trials are exposed to substantial morbidity and mortality is not based on research data. We assessed suicides, suicide attempts, and depressive symptom reduction in studies of 7 new antidepressants using the Food and Drug Administration database. Among 19,639 participating patients, 34 committed suicide (0.8% per year), and 130 attempted suicide (2.9% per year). Rates of suicide and attempted suicide did not differ significantly among the placebo- and drug-treated groups. Annual rates of suicide and attempted suicide were 0.4% and 2.7% with placebo, 0.7% and 3.4% with active comparators, and 0.8% and 2.8% with investigational antidepressants, respectively. Symptom reduction was 40.7% with investigational drugs (n = 4,510), 41.7% with active comparators (n = 1,416), and 30.9% with placebo (n = 2,805). These data may help inform discussions about the use of placebo in antidepressant clinical trials.     

Time-trends in method-specific suicide rates compared with the availability of specific compounds. The Danish experience

Restriction of means for suicide is an important part of suicide preventive strategies in different countries. All suicides in Denmark between 1970 and 2000 were examined with regard to method used for suicide. Overall suicide mortality and method-specific suicide mortality was compared with official information about availability of medical compounds (barbiturates, benzodiazepines, analgesics, antidepressants) and carbon monoxide in vehicle exhaust and household gas. Restrictions on the availability of carbon monoxide, barbiturates and dextropropoxyphen was associated with a decline in the number of suicides by self-poisoning with these compounds. Restricted access occurred concomittantly with a 55% decrease in suicide rate.     

Time-trends in method-specific suicide rates compared with the availability of specific compounds. The Danish experience

Restriction of means for suicide is an important part of suicide preventive strategies in different countries. All suicides in Denmark between 1970 and 2000 were examined with regard to method used for suicide. Overall suicide mortality and method-specific suicide mortality was compared with official information about availability of medical compounds (barbiturates, benzodiazepines, analgesics, antidepressants) and carbon monoxide in vehicle exhaust and household gas. Restrictions on the availability of carbon monoxide, barbiturates and dextropropoxyphen was associated with a decline in the number of suicides by self-poisoning with these compounds. Restricted access occurred concomittantly with a 55% decrease in suicide rate.     

Some remarks on the incidence of successful suicide in psychiatric care

Summary The total number of people who have committed suicide in the years 1965–1966, 1970–1971 and 1975–1976 in one of the counties in Northern Sweden has been scrutinized to identify the occurrence of suicide among in-patients and among former psychiatric patients. In line with other studies in the literature an increase in the number of suicides among in-patients has been found. However, there was no increase in the proportion of former patients in the suicide series. There was an increase of incidence of suicide among the group of patients for whom one month had elapsed since their last contact with psychiatric care. There was no evidence of any increase in suicide among patients treated with neuroleptic drugs. The age at suicide has declined over time for both sexes.     

Gonadal axis hormones in psychiatric male patients after a suicide attempt

Epidemiological and clinical studies support the view that aggressive acts like suicidal and violent behaviors share a common substrate. Certain aspects of violence in males have been related to high testosterone levels, but the relation of testosterone to attempted suicide has not been studied until now. We estimated plasma levels of testosterone (T), LH, and FSH in 80 male subjects after a suicide attempt and in whom a psychiatric assessment was done during their hospitalization. Suicide intent was evaluated in 72 subjects. A group of 56 healthy males in the same age range served as control. As a group, attempters showed significantly lower T levels, marginally higher LH, and normal FSH compared to controls. The attempters who used violent methods (26 subjects) had T levels even lower than the non-violent (drug overdose) subgroup. Comparisons of T levels of subgroups according to the (main) drug ingested (analgesics, benzodiazepines, antidepressants, neuroleptics, or other drugs) did not reveal any significant drug effect. In relation to diagnosis, the lowest T levels were found in the subgroup with schizophrenia (29 subjects). The T levels of this subgroup were also significantly lower compared to those of a group of 31 male schizophrenic patients, hospitalized and treated with neuroleptics. If the influence of post-attempt stress and medical condition on plasma T could be ruled out, low plasma T may prove to be a biological predictor of attempt, at least in male schizophrenic patients. Nevertheless, the findings differentiate suicidal behavior from other aggressive/violent behaviors and do not support the notion that suicidal and aggressive behaviors are manifestations of the same impulse.