Main outcome measures:Partial correlations (leastsquares method) between rates of use ofcardiovascular drugs and age standardised mortalityfrom suicide in Swedish municipalities. Hazard ratiosfor risk of suicide with adjustments for difference inage and sex in users of calcium channel blockerscompared with users of other hypertensive drugs.Results:Among the Swedish municipalities the use ofeach cardiovascular drug group except angiotensinconverting enzyme inhibitors correlated significantlyand positively with suicide rates. After adjustment forthe use of other cardiovascular drug groups, as asubstitute for the prevalence of cardiovascularmorbidity, only the correlation with calcium channelblockers remained significant (r= 0.29, P < 0.001). Inthe cohort study, five users and four non-users ofcalcium channel blockers committed suicide duringthe follow up until the end of 1994. The absolute riskassociated with use of calcium channel blockers was1.1 suicides per 1000 person years. The relative risk,adjusted for differences in age and sex, among usersversus non-users was 5.4 (95% confidence interval 1.4to 20.5).Conclusions:Use of calcium channel blockers mayincrease the risk of suicide.IntroductionA recent epidemiological study reported an excess riskof depression requiring pharmacological treatmentafter treatment with calcium channel blockers andangiotensin converting enzyme inhibitors but not aftertreatmentwithdigoxin,anti-arrhythmics,nitrates,diuretics, orblockers.1There have also been casereports suggesting depression2–5as well as psychosis6aftertreatmentwithcalciumchannelblockers. Asdepression may promote suicide we investigated pos-sible ecological associations between suicide rates andthe rates of use of eight cardiovascular drug groups in152 Swedish municipalities. In addition, we investi-gated the risk of suicide in users and non-users of cal-cium channel blockers who had purchased prescrip-tion drugs mainly used to treat hypertension.PapersSwedish Networkfor Pharmaco-epidemiology,Foundation, MalmöUniversity Hospital,SE-205 02 Malmö,SwedenGunnar Lindberg,clinical epidemiologistJonas Ranstam,biostatisticianArne Melander,professorDepartment ofPharmaceuticalServices Research,Uppsala University,Box 586, SE-751 23Uppsala, SwedenKerstin Bingefors,senior lecturerDepartment ofCommunityMedicine, LundUniversity, MalmöUniversity Hospital,SE-205 02 MalmöLennart Råstam,professorCorrespondence to:Dr Lindberg[email protected]nepi.a.seBMJ1998;316:741–5741BMJVOLUME 3167 MARCH 1998
MethodsThis report concerns two different studies: firstly, anecological study with data from Swedish municipalitieson rates of suicide and rates of use of eight groups ofcardiovascular drug groups; secondly, the hypothesisgenerated by this study tested in a cohort study on his-torical data from users of different antihypertensivedrugs.
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