Sedatives and hypnotics may increase the risk for suicide in elderly patients, according to the results of a case-control study reported online in the June issue of BMC Geriatrics.
"While antidepressant-induced suicidality is a concern in younger age groups, there is mounting evidence that these drugs may reduce suicidality in the elderly," write Anders Carlsten and Margda Waern, from Gothenburg University in Gothenburg, Sweden. "Regarding a possible association between other types of psychoactive drugs and suicide, results are inconclusive. Sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance."
The aim of this study was to evaluate the association of specific types of psychoactive drugs with suicide risk in late life, after controlling for appropriate indications. In Gothenburg and 2 adjacent counties, the investigators performed a case-control study of 85 patients 65 years or older who had committed suicide matched with 153 control subjects from a population-based comparison group.
Of the 85 suicide cases, 46 were men and 39 were women; mean age was 75 years. A psychiatrist interviewed close informants for the patients who had committed suicide, and control subjects were also interviewed face-to-face. Primary care and psychiatric records were also reviewed for case patients and control subjects, and analysis of all available data allowed diagnosis of past-month mental disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
Unadjusted analysis showed that use of antidepressant, antipsychotic, sedative, and hypnotic drugs were all associated with an increased risk for suicide, but adjusting for affective and anxiety disorders abolished this association for antidepressants in general and for selective serotonin-reuptake inhibitors (SSRIs). Adjustment for psychotic disorders abolished the association of antipsychotic use.
In the unadjusted analyses, use of sedatives was associated with nearly a 14-fold increase of suicide risk, and this persisted as an independent risk factor for suicide even after adjusting for any disorder based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. In the adjusted model, having a current prescription for a hypnotic was associated with a 4-fold increase in suicide risk.
Limitations of this study include inability to determine causality or the contribution of availability of suicide means on suicide risk, small sample size, and diagnoses of the patients who had committed suicide based on data obtained by proxy interviews.
"Sedatives and hypnotics were both associated with increased risk for suicide after adjustment for appropriate indications," the study authors write. "Given the extremely high prescription rates, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual."
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