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Fluoxetine: No Increased Suicide Risk

After fluoxetine came into widespread use, lawsuits alleged that it had caused patients to commit suicide. This could not be proved, but some confusion remained. Fluoxetine is used to treat depression, which is associated with 50% of suicides; it may be difficult to differentiate the effect of the treatment from the effect of the disease. These investigators assessed the relation between fluoxetine use and suicidal behavior using data from the National Institute of Mental Health Collaborative Depression Study, an observational, prospective project.

The incidence of suicidal behavior in 643 subjects (all white; 64% women) treated for affective disorders was marginally lower in those treated with fluoxetine or other antidepressants than in those not so treated. The risk for suicide was higher in those with more psychopathology and in those with prior suicide attempts. Each attempt marginally increased the risk for subsequent attempts. The subjects who had taken fluoxetine were more likely to have made attempts before the treatment was initiated.

Comment: Unfortunately, this study was limited to white subjects. Nevertheless, it provides reassurance that one of the most widely prescribed medications in the U.S., for one of the most common diseases, does not increase the most serious complication of that disease: suicide. Nor is there solid evidence that the medication alone is protective. Asking patients about suicide remains a necessity. <I>

— NL Stotland

Published in Journal Watch Women's Health March 1, 1999

Citation(s):

Leon AC et al. Prospective study of fluoxetine treatment and suicidal behavior in affectively ill subjects. Am J Psychiatry 1999 Feb 156 195-201.

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