Suicide attempts among patients starting depression treatment with medications or psychotherapy

Objective: This study compared the time patterns of suicide attempts among outpatients starting depression treatment with medication or psychotherapy. Method: Outpatient claims from a prepaid health plan were used to identify new episodes of depression treatment beginning with an antidepressant prescription in primary care (N=70,368), an antidepressant prescription from a psychiatrist (N=7,297), or an initial psychotherapy visit (N=54,123). Outpatient and inpatient claims were used to identify suicide attempts or possible suicide attempts during the 90 days before and 180 days after the start of treatment. Results: Overall incidence of suicide attempt was highest among patients receiving antidepressant prescriptions from psychiatrists (1,124 per 100,000), lower among those starting psychotherapy (778 per 100,000), and lowest among those receiving antidepressant prescriptions in primary care (301 per 100,000). The pattern of attempts over time was the same in all three groups: highest in the month before starting treatment, next highest in the month after starting treatment, and declining thereafter. Results were unchanged after eliminating patients receiving overlapping treatment with medication and psychotherapy. overall incidence of suicide attempt was higher in adolescents and young adults, but the time pattern was the same across all three treatments. Conclusions: The pattern of suicide attempts before and after starting antidepressant treatment is not specific to medication. Differences between treatments and changes over time probably reflect referral patterns and the expected improvement in suicidal ideation after the start of treatment.