Deliberate self-harm and antidepressant drugs - Investigation of a possible link

Background It is not clear if the frequency of deliberate self-harm ( DSH) is the same in patients taking-different pharmacological classes of antidepressant drugs. Aims To compare the frequency of DSH in patients who had been prescribed a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) prior to the DSH event. Method This was a prospective study in 2776 consecutive DSH cases attending an accident and emergency department. The incidence of DSH in TCA-treated cases and SSRI-treated cases is expressed as; number of DSH events per 10 000 prescriptions of each antidepressant. Results Significantly more DSH events occurred following the prescription of an SSRI than that of a TCA (P less than or equal to 0.001). The occurrence of DSH was highest with fluoxetine and lowest with amitriptyline. Conclusions Merely prescribing safer-in-overdose antidepressants is unlikely to reduce the overall morbidity from DSH.