Background: Anxiety (among several other symptoms) has been identified in one prospective study as associated with suicide risk in depressed patients early in treatment. It has been suggested that treatment of anxiety in depression with sedative/hypnotic agents, especially benzodiazepines, in the first several weeks may decrease suicide risk. Sedative/hypnotic agents also have depressant and disinhibitory properties which might increase suicide risk, however. This review addresses the potential benefits and risks with regard to suicide of using sedative/hypnotics as an early adjunct to antidepressant treatment in anxious depressed patients.
Methods: Pertinent medical literature was reviewed using Medline/PubMed search as well as bibliographies from related publications. Reports in English from 1958 to 2006 were included.
Results: The review did not reveal any evidence that using sedative/hypnotics as an early adjunct to antidepressant treatment of anxious depressed patients decreases their suicide risk. There is considerable evidence that sedative/hypnotics produce depressant and/or disinhibitory effects in a small proportion (perhaps 5%) of people who take them. However, there is no clear evidence that their brief use early in depression increases suicide risk. Toxicological data of suicides indicate that a majority of people who commit suicide are under the influence of sedative/hypnotic chemicals (including alcohol) at the time.
Conclusions: The authors conclude that the question of whether sedative/hypnotics may prevent or provoke suicide in anxious depressed patients cannot be answered definitively with the available information. They believe the potential risks of prescribing sedative/hypnotics for depressed patients who may be suicidal are serious. They suggest that alternatives to sedative/hypnotics should be used if early adjunctive treatment for anxiety in depressed patients is thought to be indicated.