Antidepressant use and method of suicide in the United States: variation by age and sex, 1998-2007

Suspected suicides and nonfatal suicide attempts involving antidepressants reported to United States poison control centers, 2000-2020

CONTEXT/OBJECTIVE

This study investigates characteristics of suspected suicides and nonfatal suicide attempts involving antidepressants among individuals 13 years and older reported to US poison control centers from 2000-2020.

METHODS

Data from the National Poison Data System were retrospectively analyzed.

RESULTS/DISCUSSION

There were 744,853 suspected suicides and nonfatal suicide attempts among individuals 13 years and older involving antidepressants as the first-ranked substance during the study period. Teenagers accounted for 28.6% of cases and females represented 68.7% of cases. From 2000-2019, the rate of calls received by US poison control centers for suspected suicides and nonfatal suicide attempts involving antidepressants per 100,000 US population 13 years and older increased from 17.4 to 28.4 (p < 0.0001); however, teenagers experienced the largest increase in rate from 30.4 in 2000 to 83.3 in 2019, with a rapid rate increase beginning in 2011. Individuals 60 years and older were more likely to be admitted to a health care facility than teenagers (OR: 2.18, 95% CI: 2.12-2.25). A serious medical outcome was documented in 36.3% of cases, with death occurring in 0.2% of cases. A serious medical outcome was more than twice as likely (OR: 2.57, 95% CI: 2.51-2.64) and death was 16 times more likely (OR: 16.19, 95% CI: 13.29-19.73) to occur among individuals 60 years or older than teenagers. SSRIs were most often involved (41.0%) in cases; however, TCAs had the largest proportion of serious medical outcomes (59.8%). TCAs were more likely to result in a serious medical outcome (OR: 4.36, 95% CI: 4.29-4.43) or death (OR: 12.56, 95% CI: 10.91-14.46) than SSRIs.

CONCLUSIONS

The increase in the rate of suspected suicides and nonfatal suicide attempts involving antidepressants reported to US poison control centers, particularly among teenagers, emphasizes the need for increased prevention efforts. The greater severity of medical outcomes among older adults also warrants attention.

Factors Associated with Hyponatremia in Patients Newly Prescribed Citalopram: A Retrospective Observational Study

Background

Hyponatremia is a common and under-recognized adverse drug reaction of selective serotonin re-uptake inhibitor (SSRI) antidepressants. Despite its clinical importance, there are few large-scale studies on the factors associated with hyponatremia.

Objective

The aim of this study was to determine the incidence of hyponatremia and to identify patient factors associated with hyponatremia in a large, population-based cohort initiating new prescriptions for citalopram.

Methods

We included all patients with a new prescription for citalopram during 2010–2017, inclusive, with baseline and post-initiation serum sodium values available. Data were obtained from an Alberta Health Pharmacy database to identify new citalopram prescriptions. Laboratory values for patients with new prescriptions were obtained from linked Calgary Laboratory Services data. Incident hyponatremia was defined as serum sodium level < 135 mmol/L, following prescription initiation. Associations were determined by performing Cox regression with time-varying covariate analysis, with the development of hyponatremia as the dependent variable.

Results

A total of 19,679 patients with new prescriptions were identified; 12,842 females and 6837 males. The mean age was 55.48 years (SD 21.35). Of these patients, 3250 (16.5%) developed hyponatremia, 1996 (15.5% of) females and 1254 (18.3% of) males (p = 0.002). Cox regression showed significant associations of hyponatremia with lower baseline sodium (HR 0.788), older age (HR 1.029), thiazide diuretic use (HR 1.141), and male sex (HR 1.168). Pharmaceutical manufacturer or strength of citalopram did not have significant effects on the development of hyponatremia.

Conclusion

This study provides additional data on the predictors of hyponatremia among patients initiating citalopram therapy. We report a 16.5% incidence of hyponatremia after starting citalopram treatment, and significant new findings include a higher incidence in males. This is the first published incidence of hyponatremia following the initiation of citalopram treatment across all ages in Canada.

Relationship between suicide rate and antidepressant prescription: An ecological study in the People's Republic of China

OBJECTIVES

The objective of this study was to estimate the features of suicide rate and its association with antidepressant prescriptions during the past decade in China.

METHODS

Official data on suicides were obtained and stratified by four age groups, gender, urban/rural areas, and regions (East, Central, and West). The annual antidepressant prescriptions were expressed in pills per 100 persons calculated as the volume of prescriptions divided by the total population. Negative binomial regression was carried out to examine the association between suicide and other variables.

RESULTS

Suicide rates in each stratum typically decreased from 2008 to 2015, while annual antidepressant prescriptions were generally increased by the year. The suicide rate increased with age and was greater in adult males than in females; higher in the central area and greater in rural than in urban areas. Suicide rates are negatively associated with antidepressant prescriptions including selective serotonin reuptake inhibitors (Incidence rate ratio [IRR] 0.983, 95% confidence interval [CI] 0.983-0.983), serotonin-norepinephrine reuptake inhibitors (IRR 0.951, 95% CI 0.951-0.951), tricyclic antidepressant (IRR 0.925, 95% CI 0.925-0.925) and total antidepressants (IRR 0.990, 95% CI 0.990-0.990) during 2008-2012.

CONCLUSION

Suicide varied among different studied stratum. Suicide rates are negatively associated with antidepressant prescriptions.

Voting patterns, revoking article 50 and antidepressant trends in England following the Brexit referendum

Unexpected social or economic events have been shown to negatively impact mental health and wellbeing. The result of the 2016 Brexit referendum in the UK has been associated with an increase in uncertainty and consequent anxiety. This study analyses antidepressant prescription trends in the 533 constituencies of England in the year before and three years following the referendum. We examine associations between prescription trends and constituency-level voting patterns in the referendum and later support for the March 2019 "Revoke Article 50", signed by more than 6 million UK citizens. A mixed model analysis revealed the rate of increase in antidepressant prescription trends to be steeper in Leave constituencies and in areas that did not support the petition, after controlling for constituency education, socioeconomic status, median age, total population, and seasonal effects. Proposed interpretations are provided, along with recommendations for future research. Implications for this study include redoubling mental health care service in areas that show significantly higher mental distress following a major political event.

Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century

This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.