Alcohol and serious harms of antidepressant treatment
Sharma and colleagues’ report (1) confirms that aggression and violence are associated with antidepressant treatment, especially in young people. Others have downplayed a causal link, proposing on the basis of Swedish epidemiological data that depression itself may be the cause (2). This argument falters, however, because the latter study failed to control for the high rates of antidepressant prescription in Sweden (3).
Another Swedish cohort study, cited by Sharma et al, indicates increases in violent crime in young adults, but also points to elevated rates of alcohol related crime and emergency presentation (4). The latter result aligns with our finding that antidepressants can both stimulate drinking and cause pathological intoxication, sometimes with catastrophic results (5). Alcohol use in antidepressant treated individuals is common but poorly studied; it needs to be urgently addressed as a contributor to both serious violence and suicide.
1. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
2. Fazel S, Wolf A, Chang Z, Larsson H, Goodwin GM, Lichtenstein P. Depression and violence: a Swedish population study. Lancet Psychiatry 2015;2:224-32.
3. Menkes DB, Herxheimer A. Depression and violence—what do we really know? Lancet Psychiatry 2015;2:491-2.
4. Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study. PLoS Med 2015;12(9):e1001875.
5. Menkes DB, Herxheimer A. Interaction between antidepressants and alcohol: Signal amplification by multiple case reports. International Journal of Risk and Safety in Medicine 2014;26:163-70.
Competing interests:
No competing interests
07 February 2016
David B Menkes
academic psychiatrist
Waikato Clinical Campus, Hamilton 3240, New Zealand
Rapid Response:
Alcohol and serious harms of antidepressant treatment
Sharma and colleagues’ report (1) confirms that aggression and violence are associated with antidepressant treatment, especially in young people. Others have downplayed a causal link, proposing on the basis of Swedish epidemiological data that depression itself may be the cause (2). This argument falters, however, because the latter study failed to control for the high rates of antidepressant prescription in Sweden (3).
Another Swedish cohort study, cited by Sharma et al, indicates increases in violent crime in young adults, but also points to elevated rates of alcohol related crime and emergency presentation (4). The latter result aligns with our finding that antidepressants can both stimulate drinking and cause pathological intoxication, sometimes with catastrophic results (5). Alcohol use in antidepressant treated individuals is common but poorly studied; it needs to be urgently addressed as a contributor to both serious violence and suicide.
1. Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
2. Fazel S, Wolf A, Chang Z, Larsson H, Goodwin GM, Lichtenstein P. Depression and violence: a Swedish population study. Lancet Psychiatry 2015;2:224-32.
3. Menkes DB, Herxheimer A. Depression and violence—what do we really know? Lancet Psychiatry 2015;2:491-2.
4. Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. Selective Serotonin Reuptake Inhibitors and Violent Crime: A Cohort Study. PLoS Med 2015;12(9):e1001875.
5. Menkes DB, Herxheimer A. Interaction between antidepressants and alcohol: Signal amplification by multiple case reports. International Journal of Risk and Safety in Medicine 2014;26:163-70.
Competing interests: No competing interests