Previous studies have explored the relationship between the use of antidepressant medications and self-harm events.1-5 Less is known about whether starting or stopping a medication for depression increases the likelihood of self-harm, and when patients are at greatest risk.
To better understand how risk of self-harm is influenced by starting or discontinuing antidepressants, we analyzed 8,402,030 patients with no history of self-harm or suicide attempt when initially prescribed antidepressants and 1,039,745 patients with an initial self-harm event from 2017 to 2022. We excluded patients with a prior history of self-harm or suicide attempt.
We analyzed the incidence of self-harm for patients who were currently or previously prescribed an antidepressant. As seen in Figure 1, the risk of a self-harm event is greatest soon after initial antidepressant medication prescribing with a maximum weekly rate 20 times greater than the risk of novel self-harm after discontinuation of antidepressant medication (76 per 100,000 patients compared to 3.8 per 100,000 patients).
However, the rate of self-harm is not equal across age groups. Adolescents ages 12-17 have the greatest risk in both populations. They are nearly five times more likely to experience a novel self-harm event in the first few months after being prescribed antidepressants than the overall population, as shown in Figure 2. While adolescents 12-17 are at the greatest risk of self-harm after discontinuing antidepressants compared to other age groups, their risk of self-harm after discontinuation of antidepressants does not exceed a weekly rate of 18 per 100,000 patients in the first year.
Additionally, similar to our previous study, we found that female adolescents were more likely than male adolescents to have a novel self-harm event after the start of antidepressants (414 per 100,000 females and 344 per 100,000 males at week 3).6 However, males ages 18-24 were slightly more likely to experience a novel self-harm event after the start of antidepressants than females of the same age (147 per 100,000 for males and 100 per 100,000 females at week 3).
These findings enumerate the risk of novel self-harm after discontinuation of antidepressants. Of note, the majority of patients (69%) did not have an active antidepressant prescription at the time of their initial self-harm event.
