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 More Self-Harm Events Seen With SSRI Therapy Than With Tricyclics 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.
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