Antidepressants in adult suicides in New York City: 2001-2004

Background: The U.S. Food and Drug Administration recently extended the Black Box warning on antidepressants regarding pediatric suicidality to include young adults. The decision was guided by results from meta-analyses of 372 randomized controlled clinical trials of antidepressants for adults. Nearly all suicidality in those trials was nonfatal suicide attempts and ideation. Here, we consider whether antidepressants are linked with adult suicide deaths. Method: Subjects in this medical examiner surveillance study included all suicides, 18 years and older, in New York City from 2001-2004. Postmortem blood was analyzed for the presence of antidepressants. Results: There were 1419 adult suicides in New York City during the study period. Antidepressants were detected at autopsy in 23.1% of the suicides who met criteria for toxicology analyses. Antidepressants were least prevalent in suicides aged 18-24 years (13.9%). Conclusions: Antidepressants were detected in less than one-quarter of adult suicides in New York City from 2001-2004. The majority of the suicides were not attributable to antidepressant use, and perhaps many could have been prevented with appropriate treatment. Although this study does not provide evidence for a link between antidepressant use and subsequent suicide, careful monitoring of patients receiving antidepressants remains critically important.