In 82,285 antidepressant starts, suicide attempts needing hospital peaked the month before the first prescription
"The risk of suicide attempt was highest in the month before starting antidepressant treatment and declined progressively after starting medication." Serious attempts in the six months after: 93 per 100,000 starts.
Well-supported by good-quality research. how we score evidence
Caveat on this rating: One insured population in one health plan, 1992 to 2003. No untreated comparison group, so it describes timing, not drug effect. Attempts that did not lead to admission are not counted.
If starting a drug sent people to hospital, the admissions should rise after the first prescription. This study looked at the weeks on both sides of it.
Significant findings
Simon and colleagues (American Journal of Psychiatry, 2006) used health plan records for "65,103 patients with 82,285 episodes of antidepressant treatment", counting deaths by suicide and "serious suicide attempt (suicide attempt leading to hospitalization)".
"In the 6 months after the index prescription of antidepressant treatment, 31 suicide deaths (40 per 100,000 treatment episodes) and 76 serious suicide attempts (93 per 100,000) were identified". "The risk of suicide attempt was 314 per 100,000 in children and adolescents, compared to 78 per 100,000 in adults."
"The risk of death by suicide was not significantly higher in the month after starting medication than in subsequent months. The risk of suicide attempt was highest in the month before starting antidepressant treatment and declined progressively after starting medication."
Their summary: "The risk of suicide during acute-phase antidepressant treatment is approximately one in 3,000 treatment episodes, and risk of serious suicide attempt is approximately one in 1,000."
Worth asking
This is the pattern confounding by indication predicts: people start a drug at their worst moment, so the period around the start is dangerous whatever the drug does. It does not contradict the FDA's trial analysis in this library, which found a real drug effect under age 25; the rate here was four times higher in the young. It does mean that a hospital stay soon after a first prescription is weak evidence that the prescription caused it. The weeks around a start or a dose change are the time for someone to be checking in. If you are in crisis in the US, call or text 988.
Source
Suicide risk during antidepressant treatment — Simon GE, Savarino J, Operskalski B, Wang PS (2006)
Top-tier peer-reviewed journal
Read the source: https://doi.org/10.1176/appi.ajp.163.1.41
DOI: 10.1176/appi.ajp.163.1.41
How this was scored
- Study design
- Cohort study
- Funding
- Independently funded
- Published in
- Top-tier peer-reviewed journal
- Sample size
- 65,103
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "strong evidence". Well-supported by good-quality research. It scores 70 out of 100 on our published rubric. One caveat travels with that badge: One insured population in one health plan, 1992 to 2003. No untreated comparison group, so it describes timing, not drug effect. Attempts that did not lead to admission are not counted. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Suicide risk during antidepressant treatment — Simon GE, Savarino J, Operskalski B, Wang PS (2006). Published in: Top-tier peer-reviewed journal. DOI: 10.1176/appi.ajp.163.1.41. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Cohort study. Funding: Independently funded. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.