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. 1994 Jul 23;309(6949):249–253. doi: 10.1136/bmj.309.6949.249

Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide.

N Freemantle 1, A House 1, F Song 1, J M Mason 1, T A Sheldon 1
PMCID: PMC2540780  PMID: 7832842

Abstract

OBJECTIVE--To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants. DESIGN--Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity. SETTING--United Kingdom primary care. INTERVENTIONS--Selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics. MAIN OUTCOME MEASURES--Cost per life saved and cost per life year saved. RESULTS--The potential number of lives which may be saved from a switch to the routine first line use of selective serotonin reuptake inhibitors is between 300 and 450 each year. The cost per life year gained ranges from 19,000 pounds to 173,000 pounds, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower. CONCLUSIONS--The cost per life year gained through avoiding suicides by the routine first line use of serotonin reuptake inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the serotonin reuptake inhibitors but are considerably cheaper and so are most cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beasley C. M., Jr, Dornseif B. E., Bosomworth J. C., Sayler M. E., Rampey A. H., Jr, Heiligenstein J. H., Thompson V. L., Murphy D. J., Masica D. N. Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression. BMJ. 1991 Sep 21;303(6804):685–692. doi: 10.1136/bmj.303.6804.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cassidy S., Henry J. Fatal toxicity of antidepressant drugs in overdose. Br Med J (Clin Res Ed) 1987 Oct 24;295(6605):1021–1024. doi: 10.1136/bmj.295.6605.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Clarke R. V., Lester D. Toxicity of car exhausts and opportunity for suicide: comparison between Britain and the United States. J Epidemiol Community Health. 1987 Jun;41(2):114–120. doi: 10.1136/jech.41.2.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Diekstra R. F., van Egmond M. Suicide and attempted suicide in general practice, 1979-1986. Acta Psychiatr Scand. 1989 Mar;79(3):268–275. doi: 10.1111/j.1600-0447.1989.tb10257.x. [DOI] [PubMed] [Google Scholar]
  5. Edwards J. G. Selective serotonin reuptake inhibitors. BMJ. 1992 Jun 27;304(6843):1644–1646. doi: 10.1136/bmj.304.6843.1644. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Farmer R. D., Pinder R. M. Why do fatal overdose rates vary between antidepressants? Acta Psychiatr Scand Suppl. 1989;354:25–35. doi: 10.1111/j.1600-0447.1989.tb03044.x. [DOI] [PubMed] [Google Scholar]
  7. Fawcett J., Scheftner W., Clark D., Hedeker D., Gibbons R., Coryell W. Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study. Am J Psychiatry. 1987 Jan;144(1):35–40. doi: 10.1176/ajp.144.1.35. [DOI] [PubMed] [Google Scholar]
  8. Goldacre M., Seagroatt V., Hawton K. Suicide after discharge from psychiatric inpatient care. Lancet. 1993 Jul 31;342(8866):283–286. doi: 10.1016/0140-6736(93)91822-4. [DOI] [PubMed] [Google Scholar]
  9. Gordon A., Collin J. Save the normal foreskin. BMJ. 1993 Jan 2;306(6869):1–2. doi: 10.1136/bmj.306.6869.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Henry J. A. A fatal toxicity index for antidepressant poisoning. Acta Psychiatr Scand Suppl. 1989;354:37–45. doi: 10.1111/j.1600-0447.1989.tb03045.x. [DOI] [PubMed] [Google Scholar]
  11. Henry J. A., Antao C. A. Suicide and fatal antidepressant poisoning. Eur J Med. 1992 Oct;1(6):343–348. [PubMed] [Google Scholar]
  12. Jaakkimainen L., Goodwin P. J., Pater J., Warde P., Murray N., Rapp E. Counting the costs of chemotherapy in a National Cancer Institute of Canada randomized trial in nonsmall-cell lung cancer. J Clin Oncol. 1990 Aug;8(8):1301–1309. doi: 10.1200/JCO.1990.8.8.1301. [DOI] [PubMed] [Google Scholar]
  13. Kapur S., Mieczkowski T., Mann J. J. Antidepressant medications and the relative risk of suicide attempt and suicide. JAMA. 1992 Dec 23;268(24):3441–3445. [PubMed] [Google Scholar]
  14. Kreitman N. The coal gas story. United Kingdom suicide rates, 1960-71. Br J Prev Soc Med. 1976 Jun;30(2):86–93. doi: 10.1136/jech.30.2.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Laupacis A., Feeny D., Detsky A. S., Tugwell P. X. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ. 1992 Feb 15;146(4):473–481. [PMC free article] [PubMed] [Google Scholar]
  16. Lin E. H., Von Korff M., Wagner E. H. Identifying suicide potential in primary care. J Gen Intern Med. 1989 Jan-Feb;4(1):1–6. doi: 10.1007/BF02596482. [DOI] [PubMed] [Google Scholar]
  17. Montgomery S. A., Lambert M. T., Lynch S. P. The risk of suicide with antidepressants. Int Clin Psychopharmacol. 1988 Nov;3 (Suppl 2):15–24. [PubMed] [Google Scholar]
  19. Pokorny A. D. Prediction of suicide in psychiatric patients. Report of a prospective study. Arch Gen Psychiatry. 1983 Mar;40(3):249–257. doi: 10.1001/archpsyc.1983.01790030019002. [DOI] [PubMed] [Google Scholar]
  20. Roy A. Family history of suicide. Arch Gen Psychiatry. 1983 Sep;40(9):971–974. doi: 10.1001/archpsyc.1983.01790080053007. [DOI] [PubMed] [Google Scholar]
  21. Saykin A. J., Gur R. C., Gur R. E., Mozley P. D., Mozley L. H., Resnick S. M., Kester D. B., Stafiniak P. Neuropsychological function in schizophrenia. Selective impairment in memory and learning. Arch Gen Psychiatry. 1991 Jul;48(7):618–624. doi: 10.1001/archpsyc.1991.01810310036007. [DOI] [PubMed] [Google Scholar]
  22. Song F., Freemantle N., Sheldon T. A., House A., Watson P., Long A., Mason J. Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability. BMJ. 1993 Mar 13;306(6879):683–687. doi: 10.1136/bmj.306.6879.683. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tubman T. R., Halliday H. L., Normand C. Cost of surfactant replacement treatment for severe neonatal respiratory distress syndrome: a randomised controlled trial. BMJ. 1990 Oct 13;301(6756):842–845. doi: 10.1136/bmj.301.6756.842. [DOI] [PMC free article] [PubMed] [Google Scholar]

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