Conclusion

While the 300 deaths which occur from antidepressant overdose each year in Britain are small compared with the total number of suicides (approximately 6,000 each year), it should be noted that these deaths are largely preventable by prescribing less toxic alternatives. Although it can be argued that a failed suicide attempt may only delay the ultimate outcome, it is widely accepted that a suicide attempt is a poor predictor of future attempts;21 about 10% of those who fail to kill themselves with acute overdose go on to successful suicide. Studies suggest that when a means of committing suicide becomes less available there is not, as might be thought, a shift to another method. Many suicidal acts are impulsive and quickly regretted; a thwarted or failed attempt may never be followed by another attempt. Furthermore, a failed attempt by drug overdose might bring the patient under close medical supervision and lead to more effective treatment of their depression.

This chapter has considered several of the links between depression, suicide, 5-HT and the SSRIs. It is apparent that this class of drugs enjoys a special place in the therapeutic armamentarium, with, in addition to antidepressant effectiveness, evidence that they may reduce suicidal ideation. The tricyclic drugs on the other hand may be as effective or more effective in terms of antidepressant efficacy but may increase suicidal ideation. At the same time, the SSRIs have remarkably low toxicity in overdose which makes them especially safe for the depressed patient who is considered to be at risk of suicide.

Defeat Depression

Defeat Depression

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