Antidepressant Use and Suicide Rates in Adults Aged 75 and Above: A Swedish Nationwide Cohort Study

A narrative review: suicide and suicidal behaviour in older adults

Globally, suicide is a public health concern that claims the lives of many each year. The complex etiology and factors contributing to the risk of suicide make it hard to predict the likelihood of death by suicide. Suicide rates have been increasing over the past 25 years in patients aged 65 years and older, and with the expected increases in the size of the older adult population and the under-detection of suicide risk, these rates may continue to increase. To mitigate and attempt to limit this expected increase, it is important to understand the risk and protective factors of suicide in older adults. This narrative review focuses on individuals above the age of 65 and encompasses relevant peer-reviewed publications from the past 25 years to cover fatal and non-fatal suicidal behaviour. It summarizes several important risk factors for suicide and suicidal behaviors while considering how risk can be detected, assessed, prevented, and mitigated. Screening methods to detect suicide and depression in older adults were examined based on their effectiveness and suitability for use in this population. Lastly, the impacts of the COVID-19 pandemic on suicide rates in older adults were described.

The effectiveness and safety of herbal medicine on suicidal behavior: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

Suicide is the leading cause of death worldwide. Herbal medicine (HM) has been reported to be related to clinical improvement of some risk factors for suicide including depression. This systematic review aimed to comprehensively investigate the effectiveness and safety of HM on suicidal behaviors.

METHODS

Fifteen electronic databases were searched to search relevant intervention studies, up to September 2022. The methodological quality of the included studies was assessed using the modified Cochrane risk-of-bias tool. In the included studies, outcome on suicidal behavior were analyzed, and the effect sizes were presented as mean differences (MDs) or risk ratios (RRs) with their 95% confidence intervals (CIs) through meta-analysis. The strength of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

A total of 13 randomized controlled trials (RCTs) were included in this review. Two RCTs of HM in patients with suicidal behavior found significant benefits of HM as an adjunct to fluoxetine or cognitive therapy in improving symptoms of depression. In 11 RCTs of HM in patients with other conditions, there was no statistically significant difference between HM and antidepressants in cognitive disturbance (MD, 0.12; 95% CIs, -0.20 to 0.45), a subscale of the Hamilton Rating Scale for Depression (HAMD), and suicidal ideation (0.18; -0.16 to 0.53), an item of HAMD. The overall quality of the included studies was poor. The strength of evidence assessed by GRADE was low or very low.

CONCLUSIONS

Though some of the studies reported significant benefits of HM in improving suicidal behavior in patients with depression, further clarification on some unsolved questions is needed in future well-designed clinical trials.

Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75

OBJECTIVES

Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode.

METHOD

Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode.

RESULTS

There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care.

CONCLUSION

The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.

Consumption and ocurrence of antidepressants (SSRIs) in pre- and post-COVID-19 pandemic, their environmental impact and innovative removal methods: A review

Selective serotonin reuptake inhibitors (SSRIs) are pharmaceuticals whose consumption has increased significantly. They are prescribed as first-line treatment in mental disorders such as depression, obsessive-compulsive disorder, phobias, and anxiety; also, they are indicated as adjuvants in diseases such as fibromyalgia and bulimia nervosa. In addition to being linked to the illegal market to be consumed as recreational drugs. The relevance of this review lies in the fact that worldwide consumption has increased significantly during the COVID-19 pandemic, due to the depression and anxiety that originated in the population. As a consequence of this increase in consumption, concentrations of SSRIs in the environment have increased, and these have become a relevant issue for toxicologists due to the effects that they could generate in different organisms, both aquatic and terrestrial. For this reason, the objective of this article was to do a critical evaluation of the existing data on the characteristics and physicochemical properties of SSRIs, consumption data during the COVID-19 pandemic, its occurrence in the environment and the reports of toxic effects that have been generated in different organisms; we also conclude with an updated review of different methods that have been used for their removal. With this analysis, it can be concluded that, despite SSRIs are pharmaceutical products widely studied since their launching to the market, still currently under investigation to clarify their mechanisms of action to understand the different effects on the organisms, adverse reactions, as well as possible toxicological effects on non-target organisms. On the other hand, it has been proven that although it is already possible to eliminate a significant percentage of SSRIs in the laboratory, due to their physicochemical characteristics and their behavior in complex mixtures in the environment, they have not yet been eradicated, showing a persistence in the soil, subsoil and surface waters of the entire planet that may represent a future risk.