Suicidal Thoughts May Vary by Antidepressant

Men face higher risk when taking nortriptyline than escitalopram, study finds

Posted: October 15, 2009

THURSDAY, Oct. 15 (HealthDay News) -- Men who take the antidepressant nortriptyline (Aventyl) are nearly 10 times more likely to have suicidal thoughts than those who use the antidepressant escitalopram (Lexapro, Cipralex), a new study has found.

The study, published online Oct. 15 in BMC Medicine, included 811 people with moderate to severe unipolar depression. Though it found an overall reduction in suicidal thoughts, men who took nortriptyline were found to have a 9.8-fold increase in emerging suicidal thoughts and a 2.4-fold increase in worsening suicidal thoughts, compared with those who took escitalopram.

"Our findings that treatment-emerging and worsening suicidal thoughts may also be associated with psychomotor activation triggered by antidepressants need to be investigated in future studies," the study team's leader, Dr. Nader Perroud, from the Institute of Psychiatry at King's College London, said in a news release from the journal's publisher.

"The study also refutes the idea that newer antidepressants such as the SSRIs [selective serotonin reuptake inhibitors] are worse than older medications in terms of increasing suicidal thoughts," Perroud added.

Nortriptyline is a tricyclic antidepressant that inhibits the reuptake of noradrenaline and, to a lesser degree, that of serotonin, according to background information in the news release. Escitalopram is an SSRI.

More information

The U.S. Agency for Healthcare Research and Quality has more about antidepressants.

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Pastswitch of @ Dec 07, 2009 10:55:16 AM

higher risk when taking nortriptyline?

Be VERY careful when interpreting this study!
1) It is a correlational study. It canNOT tell us cause and effect. There may well be factors that led to those in the Nortriptyline group to have more severe depression - thus leading to the published results, but having nothing to do with nortriptyline "causing" more suicidal ideation (SI). For instance, those who have more severe depression and who've failed 3 other antidepressants are more likely to get tried on the older (often higher side-effect) medicine will have "more severe" depression. Those who have severe economic stressors (maintaining depression despite medication) are more likely to be tried on the older (cheap) antidepressants. And so on.
2) The study has not been replicated, so there may have been an unrecognized procedural or statistical error made by the researchers, or the results could have been a fluke. Science requires repetition.
3) Who paid for the study? Was it maybe the makers of.....Lexapro? Let me take a guess.
Why wouldn't a news organization as smart as USNWR report who paid for (and has something to gain from) the study? That's just sloppy journalism!

Gewisn of CA @ Oct 19, 2009 13:03:02 PM

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