A large UK observational study using a primary care database found that the risk of suicide, attempted suicide or self-harm did not differ between adults with depression who were prescribed selective serotonin reuptake inhibitors (SSRIs) and those prescribed tricyclic antidepressants. For individual drugs, mirtazapine, venlafaxine and trazodone were associated with the highest rates of suicide and attempted suicide or self-harm. However, the results should be interpreted with caution because there were few suicide events overall and this study has several important limitations. The NICE guideline on depression in adults recommends that if an antidepressant is indicated it should normally be an SSRI in generic form. It also emphasises the importance of frequent monitoring of suicide risk when an antidepressant is initiated.
This link will take you to the Medicines Evidence Commentary featured in the NICE Medicines Awareness Weekly. Medicines Evidence Commentaries help contextualise important new evidence, highlighting areas that could signal a change in clinical practice. It does not constitute formal NICE guidance. The commentaries included are the opinions of contributors and do not necessarily reflect the views of NICE.