Antidepressant treatment and the risk of fatal and non-fatal self harm in first episode depression: nested case-control study
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7488.389 (Published 17 February 2005) Cite this as: BMJ 2005;330:389Data supplement
Posted as supplied by author
Supplementary material for Martinez et al: Antidepressant treatment and the risk of fatal and non-fatal self-harm in first episode depression– a nested case-control study
Approach used for the categorisation of the severity of depression
Depression was identified by a predefined set of Read and OXMIS medical terms in the patient’s record indicative of major depressive disorder, bipolar disorder, dysthymic disorder or unspecified depression. Severity of depression was categorised by one of the authors (JC), in consultation with a psychiatrist (Dr EM Bain) with general practice experience, into ‘mild’, ‘moderate’ and ‘severe’. If a patient had depression codes pertaining to different severities of depression, then the most severe category was assigned to the patient.
Method used for the estimation of duration of antidepressant exposure
Prescription duration was derived by dividing the quantity of antidepressant prescribed by the daily dose and adding a 7-day wash-out period. If no dosage instructions were entered on the prescription (18% of prescription information) we used the median of the substance-specific prescription duration of the same antidepressant from the complete study cohort. Where a new prescription for the same substance was issued within the calculated duration of the previous prescription, the overall treatment duration ended with the calculated prescription end-date plus a 7-day wash-out period.
The duration of a treatment episode was estimated from the duration of each prescription and the number of consecutive prescriptions of antidepressants allowing for gaps of up to seven days.
The duration of the first recorded treated depression episode was defined by the period between the first prescription of an antidepressant and the calculated treatment end-date plus a 180-day follow-up period. A gap of more than 180 days between the calculated end-date and a new prescription of an antidepressant defined a new episode of depression. Second and subsequent episodes of depression were not included in the analysis.
Web Table 1: Read and OXMIS medical codes for depression and severity grading
Read/OXMIS Code
Read/OXMIS Term
Grading
E113600
Recurrent major depressive episodes, in full remission
MILD
Eu33.14
[X]Seasonal depressive disorder
MILD
E204.00
Neurotic depression reactive type
MILD
E2B0.00
Postviral depression
MILD
1B17.00
Depressed
MILD
E290.00
Brief depressive reaction
MILD
Eu32z13
[X]Prolonged single episode of reactive depression
MILD
Eu33.13
[X]Recurrent episodes of reactive depression
MILD
E115600
Bipolar affective disorder, now depressed, in full remission
MILD
E200300
Anxiety with depression
MILD
Eu32000
[X]Mild depressive episode
MILD
Eu32z11
[X]Depression NOS
MILD
Eu33.12
[X]Recurrent episodes of psychogenic depression
MILD
1465.00
H/O: depression
MILD
E112600
Single major depressive episode, in full remission
MILD
Eu32.11
[X]Single episode of depressive reaction
MILD
Eu33.11
[X]Recurrent episodes of depressive reaction
MILD
Eu34100
[X]Dysthymia
MILD
E113100
Recurrent major depressive episodes, mild
MILD
E118.00
Seasonal affective disorder
MILD
E2B1.00
Chronic depression
MILD
Eu32.12
[X]Single episode of psychogenic depression
MILD
Eu32y00
[X]Other depressive episodes
MILD
1B17.11
C/O - feeling depressed
MILD
E004300
Arteriosclerotic dementia with depression
MILD
E211200
Depressive personality disorder
MILD
Eu32.13
[X]Single episode of reactive depression
MILD
Eu3y111
[X]Recurrent brief depressive episodes
MILD
3004PP
POSTOPERATIVE DEPRESSION
MILD
Eu33000
[X]Recurrent depressive disorder, current episode mild
MILD
E112100
Single major depressive episode, mild
MILD
3091PL
DEPRESSION POSTVIRAL
MILD
E115100
Bipolar affective disorder, currently depressed, mild
MILD
Eu33.15
[X]SAD - Seasonal affective disorder
MILD
Eu34111
[X]Depressive neurosis
MILD
Eu41211
[X]Mild anxiety depression
MILD
2962AF
REACTION DEPRESSIVE AFFECTIVE
MILD
3000E
ANXIETY DEPRESSION
MILD
3004A
DEPRESSION
MILD
u32400
[X]Mild depression
MILD
3004B
PREGNANCY DEPRESSION
MODERATE
E112.14
Endogenous depression
MODERATE
E112500
Single major depressive episode, partial or unspec remission
MODERATE
Eu31.11
[X]Manic-depressive illness
MODERATE
Eu31300
[X]Bipolar affect disorder cur epi mild or moderate depression
MODERATE
Eu31y11
[X]Bipolar II disorder
MODERATE
Eu33212
[X]Major depression, recurrent without psychotic symptoms
MODERATE
E115000
Bipolar affective disorder, currently depressed, unspecified
MODERATE
Eu31z00
[X]Bipolar affective disorder, unspecified
MODERATE
Eu33.00
[X]Recurrent depressive disorder
MODERATE
Eu33211
[X]Endogenous depression without psychotic symptoms
MODERATE
E113500
Recurrent major depressive episodes,partial/unspec remission
MODERATE
Eu20400
[X]Post-schizophrenic depression
MODERATE
Eu3y011
[X]Mixed affective episode
MODERATE
E112200
Single major depressive episode, moderate
MODERATE
E115500
Bipolar affect disord, now depressed, part/unspec remission
MODERATE
E2B..00
Depressive disorder NEC
MODERATE
Eu33z00
[X]Recurrent depressive disorder, unspecified
MODERATE
E002100
Senile dementia with depression
MODERATE
E002z00
Senile dementia with depressive or paranoid features NOS
MODERATE
E204.11
Postnatal depression
MODERATE
Eu02z16
[X] Senile dementia, depressed or paranoid type
MODERATE
2257.00
O/E – depressed
MODERATE
E115.00
Bipolar affective disorder, currently depressed
MODERATE
E11y.00
Other and unspecified manic-depressive psychoses
MODERATE
E11z200
Masked depression
MODERATE
Eu33z11
[X]Monopolar depression NOS
MODERATE
Eu53012
[X]Postpartum depression NOS
MODERATE
E112.00
Single major depressive episode
MODERATE
E112z00
Single major depressive episode NOS
MODERATE
Eu34114
[X]Persistant anxiety depression
MODERATE
Eu41200
[X]Mixed anxiety and depressive disorder
MODERATE
E112300
Single major depressive episode, severe, without psychosis
MODERATE
E115.11
Manic-depressive - now depressed
MODERATE
Eu32100
[X]Moderate depressive episode
MODERATE
Eu33200
[X]Recurr depress disorder cur epi severe without psyc sympt
MODERATE
Eu33y00
[X]Other recurrent depressive disorders
MODERATE
E112.12
Endogenous depression first episode
MODERATE
E113200
Recurrent major depressive episodes, moderate
MODERATE
Eu31y00
[X]Other bipolar affective disorders
MODERATE
Eu32y11
[X]Atypical depression
MODERATE
Eu53011
[X]Postnatal depression NOS
MODERATE
E112.13
Endogenous depression first episode
MODERATE
E115200
Bipolar affective disorder, currently depressed, moderate
MODERATE
E115z00
Bipolar affective disorder, currently depressed, NOS
MODERATE
E11y200
Atypical depressive disorder
MODERATE
E291.00
Prolonged depressive reaction
MODERATE
E002.00
Senile dementia with depressive or paranoid features
MODERATE
E113700
Recurrent depression
MODERATE
Eu31600
[X]Bipolar affective disorder, current episode mixed
MODERATE
Eu33213
[X]Manic-depress psychosis,depressd,no psychotic symptoms
MODERATE
ZV11111
[V]Personal history of manic-depressive psychosis
MODERATE
2962A
DEPRESSION CHRONIC
MODERATE
3004AB
OBSERVED DEPRESSION
MODERATE
3004E
EXOGENOUS DEPRESSION
MODERATE
3004ER
REACTIVE DEPRESSION
MODERATE
3004M
MORNING DEPRESSION
MODERATE
Eu33300
[X]Recurrent depress disorder cur epi severe with psyc symp
SEVERE
2962EN
ENDOGENOUS DEPRESSION
SEVERE
E11..12
Depressive psychoses
SEVERE
E113.11
Endogenous depression - recurrent
SEVERE
E113300
Recurrent major depressive episodes, severe, no psychosis
SEVERE
E115300
Bipolar affect disord, now depressed, severe, no psychosis
SEVERE
E112.11
Agitated depression
SEVERE
E113.00
Recurrent major depressive episode
SEVERE
Eu31400
[X]Bipol aff disord, curr epis sev depress, no psychot symp
SEVERE
E001300
Presenile dementia with depression
SEVERE
E113000
Recurrent major depressive episodes, unspecified
SEVERE
E11y000
Unspecified manic-depressive psychoses
SEVERE
Eu32200
[X]Severe depressive episode without psychotic symptoms
SEVERE
62T1.00
Puerperal depression
SEVERE
E115400
Bipolar affect disord, now depressed, severe with psychosis
SEVERE
E130.11
Psychotic reactive depression
SEVERE
Eu33311
[X]Endogenous depression with psychotic symptoms
SEVERE
Eu33313
[X]Recurr severe episodes/major depression+psychotic symptom
SEVERE
ZV11112
[V]Personal history of manic-depressive psychosis
SEVERE
Eu32313
[X]Single episode of psychotic depression
SEVERE
Eu33312
[X]Manic-depress psychosis,depressed type+psychotic symptoms
SEVERE
Eu33314
[X]Recurr severe episodes/psychogenic depressive psychosis
SEVERE
2960AD
DEPRESSION AGITATED
SEVERE
Eu32314
[X]Single episode of reactive depressive psychosis
SEVERE
Eu33315
[X]Recurrent severe episodes of psychotic depression
SEVERE
E135.00
Agitated depression
SEVERE
Eu31500
[X]Bipolar affect dis cur epi severe depres with psyc symp
SEVERE
Eu32300
[X]Severe depressive episode with psychotic symptoms
SEVERE
E113400
Recurrent major depressive episodes, severe, with psychosis
SEVERE
Eu33316
[X]Recurrent severe episodes/reactive depressive psychosis
SEVERE
E112000
Single major depressive episode, unspecified
SEVERE
E113z00
Recurrent major depressive episode NOS
SEVERE
Eu32311
[X]Single episode of major depression and psychotic symptoms
SEVERE
E112400
Single major depressive episode, severe, with psychosis
SEVERE
E130.00
Reactive depressive psychosis
SEVERE
Eu32212
[X]Single episode major depression w'out psychotic symptoms
SEVERE
2962C
PSYCHOSIS DEPRESSIVE
SEVERE
2969M
PSYCHOSIS MANIC-DEPRESSIVE
SEVERE
3004C
PUERPERAL DEPRESSION
SEVERE
2960AC
CHRONIC AGITATED DEPRESSION
SEVERE
2980
REACTION DEPRESSIVE PSYCHOTIC
SEVERE
Web Table 2: Read and OXMIS medical codes for completed suicides
Read/OXMIS code
Read/OXMIS term
Read/OXMIS code
Read/OXMIS term
9670A
BARBITURATE OVERDOSE
TKx0.00
Suicide + selfinflicted injury-jump/lie before moving object
SL...15
Overdose of drug
U200z00
[X]Intent self poison nonopioid analgesic unspecif place
TK...13
Poisoning – self-inflicted
U209.00
[X]Intent self poison/exposure to alcohol
TK00.00
Suicide + selfinflicted poisoning by analgesic/antipyretic
U20A400
[X]Int self poison org solvent,halogen hydrocarb,in highway
TKx5.00
Suicide and selfinflicted injury by crashing motor vehicle
U20y.00
[X]Intent self poison/exposure to unspecif chemical
U2...00
[X]Intentional self-harm
U22..00
[X]Intentional self harm by drowning and submersion
U202.16
[X]Overdose – benzodiazepine
U24..00
[X]Intent self harm by rifle shotgun/larger firearm disch
U204.12
[X]Overdose – amitriptyline
U2z..00
[X]Intentional self harm by unspecified means
U20C.00
[X]Intent self poison/exposure to pesticide
U45..00
[X]Other+unspecified firearm discharge undetermined intent
U2D4.00
[X]Intent self harm by crash motor vehicl occ street/highway
U4B..00
[X]Falling jumping/pushed from high place undeterm intent
U2y..00
[X]Intentional self harm by other specified means
9947TA
STRANGULATION ATTEMPTED
TK3..00
Suicide + selfinflicted injury by hang/strangulate/suffocate
TK0..00
Suicide + selfinflicted poisoning by solid/liquid substances
TK5..00
Suicide and selfinflicted injury by firearms and explosives
TK20.00
Suicide + selfinflicted poisoning by motor veh exhaust gas
U2...13
[X]Suicide
TK31.00
Suicide + selfinflicted injury by suffocation by plastic bag
U20..00
[X]Intentional self poisoning/exposure to noxious substances
TK51.00
Suicide and selfinflicted injury by shotgun
U200000
[X]Int self poison/exposure to nonopioid analgesic at home
TK6z.00
Suicide and selfinflicted injury by cutting and stabbing NOS
U202.17
[X]Overdose – barbiturate
TKx4.00
Suicide and selfinflicted injury by electrocution
U205z00
[X]Intent self poison narcotic drug unspecif place
TKz..00
Suicide and selfinflicted injury NOS
U208z00
[X]Intent self poison oth/unsp drug/medic unspecif place
U221.00
[X]Intent self harm by drowning/submersn occ resid instit'n
U209z00
[X]Intent self poison alcohol unspecif place
U2C..00
[X]Intent self harm by jumping / lying before moving object
U20By00
[X]Int self poison other gas/vapour other spec place
U2D..00
[X]Intentional self harm by crashing of motor vehicle
U21..00
[X]Intent self harm by hanging strangulation / suffocation
U30..11
[X]Deliberate drug poisoning
U27..00
[X]Intentional self harm by smoke, fire and flames
9947TS
STRANGULATION
U2D0.00
[X]Intent self harm by crash of motor vehicl occurrn at home
SN47z00
Asphyxiation or strangulation NOS
9947TR
ASPHYXIA DUE STRANGULATION
TK03.00
Suicide + selfinflicted poisoning tranquilliser/psychotropic
TK70.00
Suicide+selfinflicted injury-jump from residential premises
TK04.00
Suicide + selfinflicted poisoning by other drugs/medicines
TK7z.00
Suicide+selfinflicted injury-jump from high place NOS
TK4..00
Suicide and selfinflicted injury by drowning
TKxz.00
Suicide and selfinflicted injury by other means NOS
U2...11
[X]Self inflicted injury
U2...14
[X]Attempted suicide
U200.00
[X]Intent self poison/exposure to nonopioid analgesic
U202.00
[X]Intent self poison/exposure to sedative hypnotic
U200.12
[X]Overdose - ibuprofen
U202.11
[X]Overdose - sleeping tabs
U202.12
[X]Overdose - diazepam
U204z00
[X]Intent self poison psychotropic drug unspecif place
U202.14
[X]Overdose - flurazepam
U205000
[X]Int self poison/exposure to narcotic drug at home
U205.11
[X]Overdose - heroin
U209000
[X]Int self poison/exposure to alcohol at home
U208.00
[X]Int self poison/exposure to other/unspec drug/medicament
U20B.11
[X]Self carbon monoxide poisoning
U210.00
[X]Intent self harm by hanging strangulat/suffocat occ home
U290.00
[X]Intentional self harm by sharp object occurrence at home
U29..00
[X]Intentional self harm by sharp object
U44..00
[X]Rifle shotgun+larger firearm discharge undetermin intent
9779DL
DELIBERATE OVERDOSE (DRUG)
SL...14
Overdose of biological substance
SN47100
Suffocation by strangulation
TK05.00
Suicide + selfinflicted poisoning by drug or medicine NOS
TK...00
Suicide and selfinflicted injury
TK1..00
Suicide + selfinflicted poisoning by gases in domestic use
TK06.00
Suicide + selfinflicted poisoning by agricultural chemical
TK52.00
Suicide and selfinflicted injury by hunting rifle
TK60.00
Suicide and selfinflicted injury by cutting
U200.13
[X]Overdose – aspirin
U20..11
[X]Deliberate drug overdose / other poisoning
U201.00
[X]Intent self poison/exposure to antiepileptic
U202.13
[X]Overdose - temazepam
U202.15
[X]Overdose – nitrazepam
U202.18
[X]Overdose - amylobarbitone
U204000
[X]Int self poison/exposure to psychotropic drug at home
U20A.00
[X]Intentional self poison organ solvent,halogen hydrocarb
U207.00
[X]Intent self poison/exposure to oth autonomic drug
U20B000
[X]Int self poison/exposure to other gas/vapour at home
U2B..00
[X]Intentional self harm by jumping from a high place
U242.00
[X]Int slf hrm rifl s'gun/lrg frarm dis sch/ins/pub adm area
U2B4.00
[X]Intent self harm by jump from high place occ street/h'way
U291.00
[X]Intent self harm by sharp object occ resident instit'n
TK...15
Attempted suicide
U29z.00
[X]Intentional self harm by sharp object occ unspecif place
TKx0000
Suicide + selfinflicted injury-jumping before moving object
U2A1.00
[X]Intent self harm by blunt object occ resident instit'n
U20A.11
[X]Self poisoning from glue solvent
U2C1.00
[X]Int self harm jump/lying befr mov obje occ resid instit'n
9947HN
ASPHYXIA DUE HANGING
U2y0.00
[X]Intentionl self harm by oth specif means occurrn at home
TK...14
Suicide and self harm
U41..00
[X]Hanging strangulation + suffocation undetermined intent
TK7..00
Suicide and selfinflicted injury by jumping from high place
TK...11
Cause of overdose - deliberate
TKx1.00
Suicide and selfinflicted injury by burns or fire
TK02.00
Suicide + selfinflicted poisoning by oth sedatives/hypnotics
TKx2.00
Suicide and selfinflicted injury by scald
TK0z.00
Suicide + selfinflicted poisoning by solid/liquid subst NOS
TKxy.00
Suicide and selfinflicted injury by other specified means
TK10.00
Suicide + selfinflicted poisoning by gas via pipeline
U200.11
[X]Overdose – paracetamol
TK1y.00
Suicide and selfinflicted poisoning by other utility gas
U202000
[X]Int self poison/exposure to sedative hypnotic at home
TK21.00
Suicide and selfinflicted poisoning by other carbon monoxide
U204.00
[X]Intent self poison/exposure to psychotropic drug
TK61.00
Suicide and selfinflicted injury by stabbing
U204.11
[X]Overdose – antidepressant
TKx..00
Suicide and selfinflicted injury by other means
U204.13
[X]Overdose – SSRI
U202z00
[X]Intent self poison sedative hypnotic unspecif place
U205.00
[X]Intent self poison/exposure to narcotic drug
U207z00
[X]Intent self poison oth autonomic drug unspecif place
U205y00
[X]Int self poison narcotic drug other spec place
U20B200
[X]Int self poison other gas/vapour school/pub admin area
U2zz.00
[X]Intent self harm by unspecif means occ at unspecif place
U2A0.00
[X]Intentional self harm by blunt object occurrence at home
9947TC
SUICIDE ATTEMPT STRANGULATION
U2A3.00
[X]Intent self harm by blunt object occ sports/athlet area
TK01.00
Suicide + selfinflicted poisoning by barbiturates
3009C
SUICIDE ATTEMPT
TK07.00
Suicide + selfinflicted poisoning by corrosive/caustic subst
3009D
SUICIDE
TK1z.00
Suicide + selfinflicted poisoning by domestic gases NOS
3059FN
SELF-INFLICTED INJURY
TK30.00
Suicide and selfinflicted injury by hanging
9651D
OVERDOSE ASPIRIN
TK3y.00
Suicide + selfinflicted inj oth mean hang/strangle/suffocate
9779A
OVERDOSE DRUG(S)
TK3z.00
Suicide + selfinflicted inj by hang/strangle/suffocate NOS
9779L
OVERDOSE DRUG SUICIDAL
TK6..00
Suicide and selfinflicted injury by cutting and stabbing
9779NA
SUICIDAL OVERDOSE (DRUG)
Identification of suicides
Potential cases of suicide were identified from a list of OXMIS/Read medical terms indicative of suicide and by review of all free text entries for patients who had died of any cause during the observation period.
The Read/OXMIS medical terms and the extracted free text were used by two of the authors independently (CM and DG), blinded to drug exposure category, to assess the likelihood of a suicide, the method and the date of suicide. Where there was disagreement, a consensus opinion was reached. Patients with a code of suicide or with a clear free text entry of suicide were classified as "definite suicide". Other deaths were coded as probable or possible suicides or ‘unknown’ depending on the mode of death and drugs taken in overdose. Subjects with a clearly stated natural cause of death were not considered further.
For all definite, probable or possible cases of suicide and those deaths where the cause of death was unknown, we contacted the general practice to obtain the patient’s date of birth using the anonymised patient identifier. This patient identifier together with the patient’s gender, date of birth and date of death were then provided to the Office for National Statistics (ONS) who provided the cause of death for all matched death certificates.
Suicide verdicts coded with E950-E959 (ICD-9) or X60-X84 (ICD-10) and open verdicts coded as E980-E989 (ICD-9) and Y10-Y34 (ICD-10) on the death certificates were defined as suicides. In keeping with other studies we included as suicides people coded as either suicide or undetermined deaths, as most deaths in this latter category are suicides [1].
We obtained death certificate data from ONS for 73 of 117 (62%) of the possible suicides. It was not possible to obtain a unique match to ONS death certificate data using gender, date of birth and date of death for the remaining cases.
All 32 cases of suicide coded by CM and DG as "definite" for whom ONS death certificate data were obtained were recorded as suicides on the death certificates. Amongst those coded "probable", 67% (8/12) were recorded as suicides; amongst those coded "possible", 50% (4/8) were recorded as suicide and 8% (2/24) of the deaths where the cause was unknown were recorded as suicides. As the coding of "definite" and "probable" suicides was reasonably accurate, we assumed that all deaths without death certificate information coded as probable suicides were indeed suicides. We excluded possible suicides (n=3) without death certificate support for the cause of death from further analysis.
[1] Linsley KR, Schapira K, Kelly TP. Open verdict v. suicide — importance to research. Br. J. Psychiatry, May 2001; 178: 465 - 468.
Web Table 3: Cumulated exposure to specific antidepressants during the entire observational period
Number of patients with depression
Person-years
SSRI substance
99829
37775
Citalopram
13723
4708
Fluoxetine
43031
13974
Fluvoxamine
9446
2571
Paroxetine
34931
12868
Sertraline
10475
3834
TCA substance
59958
21777
Amitriptyline
12135
4245
Amoxapine
21
9
Clomipramine
1667
673
Dothiepin
30665
10893
Doxepin
630
222
Imipramine
1382
429
Lofepramine
14783
3929
Nortriptyline
419
102
Trazodone
2766
1076
Trimipramine
730
245
Tricyclic related TCA
Mianserin
159
64
Maprotiline
46
11
Viloxazine
7
1
Other AD
9610
3716
Flupentixol
2529
565
Isocarboxazid
3
1
Moclobemide
99
48
Mirtazapine
1354
431
Nefazodone
850
309
Phenelzine
19
14
Reboxetine
449
147
Tranylcypromine
5
3
Tryptophan
4
5
Venlafaxine
5049
2224
Total exposure to antidepressants
146095
62227
*The total number of subjects exceeds the cohort size as some subjects received more than one antidepressant over the study period
Web Table 4: Risk of non-fatal self-harm and completed suicide in relation to time since stopping antidepressant therapy (all ages) (<14 days; 15-30 days; 31-60 days and 61-180 days)
Non fatal self-harm
Completed suicides
Exposure
Cases
n=624
Controls
n=14541Crude OR
(95% CI)Adjusted OR*
(95% CI)*Cases
n=33
Controls
n=457Crude OR
(95% CI)Adjusted OR*
(95% CI)TCA
136
3637
1
1
9
148
1
1
SSRI
356
8998
1.07 (0.87-1.32)
1.11 (0.90-1.37)
17
252
1.16 (0.49-2.76)
1.13 (0.46-2.78)
Other antidepressants
33
526
1.60 (1.08-2.39)
1.13 (0.75-1.73)
2
22
-
-
Co-exposure to more than one antidepressant†
99
1380
1.75 (1.32-2.30)
1.19 (0.89-1.61)
5
35
2.46 (0.74-8.17)
1.01 (0.22-4.59)
Time since stopping
<14 days
148
2660
9
73
TCA
33
703
1
1
3
31
1
1
SSRI
106
1854
1.33 (0.88-2.01)
1.39 (0.92-2.11)
5
40
1.90 (0.39-9.35)
1.74 (0.32-9.34)
15-30 days
77
1970
3
68
TCA
19
525
1
1
0
21
-
-
SSRI
52
1355
1.11 (0.65-1.90)
1.07 (0.62-1.85)
2
44
-
-
31-60 days
119
2778
7
88
TCA
33
785
1
1
4
26
1
1
SSRI
76
1868
0.96 (0.63-1.47)
1.05 (0.68-1.62)
3
58
0.32 (0.06-1.62)
0.23 (0.04-1.40)
0
4
-
-
61-180 days
181
5753
9
193
TCA
51
1624
1
1
2
70
-
-
SSRI
122
3921
0.97 (0.69-1.36)
0.99 (0.70-1.38)
7
110
-
-
*Adjusted for severity of depression, time of depression diagnosis in relation to start of therapy, referral to psychiatrist or psychologist prior to index day, past history of self-harm, diagnosis of or treatment for anxiety or panic disorder, schizophrenia, antipsychotic medication, drug misuse and alcohol abuse. † includes any co-exposure to more than one AD of the same class or different classes
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