1/11/2001 – More Self Harm Seen with SSRI Therapy Than With Tricyclics

Now, a report out of the UK debunks a popular marketing
strategem of SSRI manufacturers–that SSRI’s are inherently
safer because they are less toxic in overdose. This study
recently published in the British Journal of Psychiatry clearly
points to a great risk of self-harm with drugs like Prozac, Zoloft
and Paxil over the older tricyclic antidepressants. Mark
———

More Self Harm Seen with SSRI Therapy Than With Tricyclics

http://psychiatry.medscape.com/reuters/prof/2000/12/12.29/20001228clin013.html

WESTPORT, CT (Reuters Health) Dec 28 – Significantly more
instances of deliberate self-harm occur in patients prescribed a
selective serotonin reuptake inhibitor (SSRI) than in those
prescribed a tricyclic antidepressant (TCA). In their report in the
December issue of the British Journal of Psychiatry, UK
investigators caution that the choice of antidepressant for
patients at risk should not be based solely on overdose toxicity.

In this prospective study, 2776 deliberate self-harm events
occurred in 1954 individuals attending the Derbyshire Royal
Infirmary in 1995 and 1996. Dr. Stuart Donovan, of University
Hospital, in Nottingham, and associates observed that the most
frequent method of self-harm was medication overdose, and
paracetamol (acetaminophen) was the medication most
frequently involved

In the cases of antidepressant overdoses, SSRIs were used
more often than TCAs, in 16.0 and 11.8 cases per 10,000
prescriptions, respectively. The relative incidence of self-harm
events was significantly higher in those prescribed SSRIs than
in those prescribed TCAs. Exposure times were similar for the
two types of drugs.

Dr. Donovan’s group adds that SSRIs may have been prescribed
more often following unsuccessful use of a TCA, making it
possible that “a greater proportion of more ‘difficult to treat’
patients may have been prescribed SSRIs and this may
manifest as a greater risk of deliberate self-harm.” However, they
emphasize that the reduced overdose toxicity of SSRIs
compared with TCAs “does not extrapolate to a reduced risk of
deliberate self-harm.”

In fact, the reduced risk of morbidity following overdose is offset
by the higher risk of self-harm by other methods in patients
taking SSRIs.

Br J Psychiatry 2000;177:551-556.
Copyright © 2000 Reuters Ltd. All rights reserved.

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