OBJECTIVE: To assess a possible relationship between treatment with bupropion (vs placebo) and expressed suicidal ideation and behavior. DATA SOURCES: This analysis, based on the US Food and Drug Administration's (FDA's) analysis of antidepressant suicidality data, included 8,953 adult subjects receiving bupropion and 6,520 adult subjects receiving placebo from randomized, placebo-controlled trials with bupropion conducted between 1976 and 2006 across multiple indications, including major depressive disorder (MDD). A text string search of the adverse event database and case report form comments was performed to identify potential suicidal events. FDA search criteria included the following text strings: accident-, injur-, suic-, or overdos-, including all events coded as accidental overdose, attempt, cut, gas, hang, hung, jump, mutilat-, self damag-, self harm, self inflict-, shoot, slash, poison, asphyxiation, suffocation, firearm, burn, drown, gun, immolat-, and monoxide, and the following terms were added by GlaxoSmithKline to the search criteria: accident, lacerat-, MVA, and hospital. The database search included data beginning from the first dose of study medication through 1 day following the last dose. DATA EXTRACTION: Suicidal event narratives were classified using the Columbia Classification Algorithm for Suicide Assessment. Additionally, changes on rating scale items for depressed mood and suicidality were analyzed. DATA SYNTHESIS: In the MDD population, the incidence of suicidal behavior or ideation was 17/3,179 (0.53%) versus 11/2,310 (0.48%) for the bupropion and placebo groups, respectively (OR = 1.28; 95% CI, 0.59-2.86). For suicidal behavior, the incidence was 8/3,179 (0.25%) versus 2/2,310 (0.09%), respectively (OR = 3.52; 95% CI, 0.81-24.48). No suicidal behavior event was noted in the other indications, and no completed suicides were reported during treatment. No significant worsening was observed for bupropion relative to placebo on the rating scale items. No differential treatment effects were observed by gender or age; regardless of treatment, however, the 18- to 24-year-old group had the greatest odds of having a suicide event. CONCLUSIONS: Although no statistically significant differences were observed between bupropion and placebo in expressed suicidal ideation or behavior, we believe that all patients treated with antidepressants should receive careful monitoring for clinical worsening, suicidality, or unusual changes in behavior.
OBJECTIVE: To assess a possible relationship between treatment with bupropion (vs placebo) and expressed suicidal ideation and behavior. DATA SOURCES: This analysis, based on the US Food and Drug Administration's (FDA's) analysis of antidepressant suicidality data, included 8,953 adult subjects receiving bupropion and 6,520 adult subjects receiving placebo from randomized, placebo-controlled trials with bupropion conducted between 1976 and 2006 across multiple indications, including major depressive disorder (MDD). A text string search of the adverse event database and case report form comments was performed to identify potential suicidal events. FDA search criteria included the following text strings: accident-, injur-, suic-, or overdos-, including all events coded as accidental overdose, attempt, cut, gas, hang, hung, jump, mutilat-, self damag-, self harm, self inflict-, shoot, slash, poison, asphyxiation, suffocation, firearm, burn, drown, gun, immolat-, and monoxide, and the following terms were added by GlaxoSmithKline to the search criteria: accident, lacerat-, MVA, and hospital. The database search included data beginning from the first dose of study medication through 1 day following the last dose. DATA EXTRACTION: Suicidal event narratives were classified using the Columbia Classification Algorithm for Suicide Assessment. Additionally, changes on rating scale items for depressed mood and suicidality were analyzed. DATA SYNTHESIS: In the MDD population, the incidence of suicidal behavior or ideation was 17/3,179 (0.53%) versus 11/2,310 (0.48%) for the bupropion and placebo groups, respectively (OR = 1.28; 95% CI, 0.59-2.86). For suicidal behavior, the incidence was 8/3,179 (0.25%) versus 2/2,310 (0.09%), respectively (OR = 3.52; 95% CI, 0.81-24.48). No suicidal behavior event was noted in the other indications, and no completed suicides were reported during treatment. No significant worsening was observed for bupropion relative to placebo on the rating scale items. No differential treatment effects were observed by gender or age; regardless of treatment, however, the 18- to 24-year-old group had the greatest odds of having a suicide event. CONCLUSIONS: Although no statistically significant differences were observed between bupropion and placebo in expressed suicidal ideation or behavior, we believe that all patients treated with antidepressants should receive careful monitoring for clinical worsening, suicidality, or unusual changes in behavior.
Authors: Jack G Modell; Norman E Rosenthal; April E Harriett; Alok Krishen; Afsaneh Asgharian; Vicki J Foster; Alan Metz; Carol B Rockett; Donna S Wightman Journal: Biol Psychiatry Date: 2005-10-15 Impact factor: 13.382
Authors: Steven J Garlow; Becky Kinkead; Michael E Thase; Lewis L Judd; A John Rush; Kimberly A Yonkers; David J Kupfer; Ellen Frank; Pamela J Schettler; Mark Hyman Rapaport Journal: J Psychiatr Res Date: 2013-06-17 Impact factor: 4.791
Authors: J Kim Penberthy; J Morgan Penberthy; Marcus R Harris; Sonali Nanda; Jennifer Ahn; Caridad Ponce Martinez; Apule O Osika; Zoe A Slepian; Justin C Forsyth; J Andrew Starr; Jennifer E Farrell; Joshua N Hook Journal: Subst Abuse Date: 2016-04-12
Authors: Elise M Hawkins; William Coryell; Stephen Leung; Sagar V Parikh; Cody Weston; Paul Nestadt; John I Nurnberger; Adam Kaplin; Anupama Kumar; Ali A Farooqui; Rif S El-Mallakh Journal: Brain Behav Date: 2021-10-17 Impact factor: 2.708