Reporting of drug induced depression and fatal and non-fatal suicidal behaviour in the UK from 1998 to 2011

BMC Clinical Pharmacology

David Gunnell²  Munir Pirmohamed⁴  John Potokar¹  Richard M Martin²  Kyla H Thomas³ 

[1]The Academic Unit of Psychiatry, University of Bristol Bristol, UK

[2]School of Social and Community Medicine, University of Bristol, Canynge Hall 39 Whatley Road, Bristol BS8 2PS, UK

[3]Health and Wellbeing Division, Department for Children, Adults and Health, South Gloucestershire Council Badminton Road, Yate, Bristol, UK

[4]Centre for Drug Safety Science, University of Liverpool Liverpool, UK

关键词: Adverse effects;    Yellow card;    Depression;    Self injury;    Non-fatal suicidal behaviour;    Suicide;    Adverse drug reaction;   

Others  :  1084717
DOI  :  10.1186/2050-6511-15-54

 received in 2014-03-23, accepted in 2014-09-23,  发布年份 2014

【 摘 要 】

Background

Psychiatric adverse drug reactions (ADRs) are distressing for patients and have important public health implications. We identified the drugs with the most frequent spontaneous reports of depression, and fatal and non-fatal suicidal behaviour to the UK’s Yellow Card Scheme from 1998 to 2011.

Methods

We obtained Yellow Card data from the Medicines and Healthcare products Regulatory Agency for the drugs with the most frequent spontaneous reports of depression and suicidal behaviour from 1964 onwards. Prescribing data were obtained from the NHS Information Centre and the Department of Health. We examined the frequency of reports for drugs and estimated rates of reporting of psychiatric ADRs using prescribing data as proxy denominators from 1998 to 2011, as prescribing data were not available prior to 1998.

Results

There were 110 different drugs with ≥ 20 reports of depression, 58 with ≥10 reports of non-fatal suicidal behaviour and 33 with ≥5 reports of fatal suicidal behaviour in the time period. The top five drugs with the most frequent reports of depression were the smoking cessation medicines varenicline and bupropion, followed by paroxetine (a selective serotonin reuptake inhibitor), isotretinoin (used in acne treatment) and rimonabant (a weight loss drug). Selective serotonin reuptake inhibitors, varenicline and the antipsychotic medicine clozapine were included in the top five medicines with the most frequent reports of fatal and non-fatal suicidal behaviour. Medicines with the highest reliably measured reporting rates of psychiatric ADRs per million prescriptions dispensed in the community included rimonabant, isotretinoin, mefloquine (an antimalarial), varenicline and bupropion. Robust denominators for community prescribing were not available for two drugs with five or more suicide reports, efavirenz (an antiretroviral medicine) and clozapine.

Conclusions

Depression and suicide-related ADRs are reported for many nervous system and non-nervous system drugs. As spontaneous reports cannot be used to determine causality between the drug and the ADR, psychiatric ADRs which can cause significant public alarm should be specifically assessed and reported in all randomised controlled trials.

【 授权许可】

   
2014 Thomas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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