Raja Michele, Azzoni Antonella, Koukopoulos Alexia E
Servizio Psichiatrico di Diagnosi e Cura, Ospedale Santo Spirito in Sassia, Rome, Italy.
J Affect Disord. 2009 Feb;113(1-2):37-44. doi: 10.1016/j.jad.2008.04.024. Epub 2008 Jun 9.
It is difficult to assess the effectiveness of treatments in lowering suicide incidence.
To ascertain the impact of antidepressants (AD) on suicidal behavior, we compared the psychopharmacological treatment taken in the previous 3 months by cases who had made or not a suicide attempt (SA) just before their admission to a hospital.
In comparison with not SA cases, SA cases were more likely to have received AD and benzodiazepines (BZD) before hospitalization. On the contrary, they were less likely to have received antipsychotics, antiepileptic mood stabilizers, and lithium. Similar results were observed when the analysis was restricted to cases with a diagnosis of Major Depression, Bipolar Depression or Bipolar Mixed state, Schizoaffective Disorder, Depressive or Mixed type. Previous AD treatment seemed to be not related to the severity of psychopathology in general or to the severity of depressive and anxiety symptoms.
The results suggest that the use of AD in patients with mood disorders is not associated with a reduction of SA rate. Rather, it is not possible to exclude that AD or BZD can induce, worsen, or precipitate suicidal behavior in some patients, especially in those affected by mood disorders with Depressive or Mixed features. The results must be considered preliminary since this is an open, non-randomized, non-controlled study that was carried out at a single facility.
评估治疗方法在降低自杀发生率方面的有效性具有难度。
为确定抗抑郁药（AD）对自杀行为的影响，我们比较了在入院前刚有或未有自杀未遂（SA）情况的病例在过去3个月内接受的精神药物治疗。
与无自杀未遂病例相比，自杀未遂病例在住院前更有可能接受过抗抑郁药和苯二氮䓬类药物（BZD）治疗。相反，他们接受抗精神病药物、抗癫痫心境稳定剂和锂盐治疗的可能性较小。当分析仅限于诊断为重度抑郁症、双相抑郁症或双相混合状态、精神分裂症性障碍、抑郁或混合型的病例时，观察到了类似结果。既往抗抑郁药治疗似乎一般与精神病理学的严重程度或抑郁和焦虑症状的严重程度无关。
结果表明，在心境障碍患者中使用抗抑郁药与自杀未遂率的降低无关。相反，无法排除抗抑郁药或苯二氮䓬类药物在某些患者中，尤其是在那些患有具有抑郁或混合特征的心境障碍患者中，可能诱发、加重或促使自杀行为发生。由于这是一项在单一机构进行的开放性、非随机、非对照研究，这些结果必须被视为初步结果。
