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School of Community Health Sciences, Division of Public Health medicine and Epidemiology, University Hospital, Queen's Medical Centre, Nottingham;
Deliberate Self Harm Team, The Litchurch Centre, Southern Derbyshire Mental Health Trust, Derby
Correspondence: Dr Stuart Donovan, The Croft, 44 Lower Stanton Road, Ilkeston, Derbyshire DE74LN, UK; fax: 0115 932 1453; e-mail: mercedes{at}redmerc.freeserve.co.uk
Declaration of interest Support was received from the University of Nottingham and the Southern Derbyshire Health Authority. An unconditional contribution to postage and data analysis costs was received from the pharmaceutical industry.
Background It is not clear if the frequency of deliberate self-harm (DSH) is the same in patients taking different pharmacological classes of antidepressant drugs.
Aims To compare the frequency of DSH in patients who had been prescribed a tricyclic antidepressant (TCA) or a selective serotonin reuptake inhibitor (SSRI) prior to the DSH event.
Method This was a prospective study in 2776 consecutive DSH cases attending an accident and emergency department. The incidence of DSH in TCA-treated cases and SSRI-treated cases is expressed as number of DSH events per 10 000 prescriptions of each antidepressant.
Results Significantly more DSH events occurred following the prescription of an SSRI than that of a TCA (P <0.001). The occurrence of DSH was highest with fluoxetine and lowest with amitriptyline.
Conclusions Merely prescribing safer-in-overdose antidepressants is unlikely to reduce the overall morbidity from DSH.
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