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A seminal study finds that the number of requests for suicides declines when patients are successfully treated for depression.

The research could have a significant impact on the assisted suicide debate as pro-life advocates have long said patients mostly seek help killing themselves when coping with severe depression. Group Health researchers conducted the study by examining more than 100,000 patients treated for depression and found that suicide attempts declined during the first month of treatment.

Suicide attempts were most likely the month before the start of treatment and fell by at least 50 percent the month after treatment. Suicide requests steadily declined as time progressed following treatment.

The findings held regardless of whether the patient was treated with medication, psychotherapy, or both. The results have an important bearing on the state of Oregon, the only one to allow assisted suicide. That’s because virtually all of the patients who killed themselves with their doctor’s help in 2006 did not receive any treatment for depression beforehand.

“Only two of the 46 patients dying from assisted suicide in 2006 were referred for psychiatric evaluation, yet depression is the most common cause of suicidal ideation,” Physicians for Compassionate Care told in March after analyzing the latest state health department report. Publishing their results in the July edition of the American Journal of Psychiatry, the survey showed a similar pattern of fewer requests for both young adults (up to age 24) as for older adults.

Younger adults were twice as likely to request suicide as older adults, but both groups showed the same patterns in terms of the significant reduction of suicide requests after treatment.

Greg Simon, MD, MPH, the Group Health psychiatrist who led the study, says it is a seminal one because it’s the first to compare the risk of suicide attempts before and after the start of treatment with both antidepressants but also psychotherapy. “Our study indicates that there’s nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves–or protect them from suicidal thoughts,” said Dr. Simon.

“Instead, we think that, on average, starting any type of treatment–medication, psychotherapy, or both–helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it.” The survey also found that patients who received anti-depression drugs from a psychiatrist were more likely to request suicide than getting the drugs from their primary care physician. This shows the importance of treating doctors to patients in terms of their mental health.

“That’s not because seeing a psychiatrist makes you want to kill yourself,” Dr. Simon said in a statement. Instead, it is more likely because patients with severe depression get psychiatric consults while those with more milder forms of depression can be treated by the primary physician.

However, this also has an important impact in Oregon as Physicians for Compassionate Care says few of the patients who died in assisted suicides there had a true doctor-patient relationship.

“The prescribing physician was present when medication was ingested for only 15 of the 46 deaths; knowledge of complications for the other 31 patients is obtained second or third-hand,” the group said.

“The median duration of the patient-physician relationship was only 15 weeks, with a range from one to 767 weeks,” which the group says undermines the premise of physician-assisted suicide. “We know that many of these patients are receiving prescriptions for lethal medications from doctors that are new to them, rather than from their usual doctor.”

As a result, requiring anti-depression treatment before an assisted suicide can be allowed and requiring a longer doctor-patient relationship beforehand could dramatically shrink the number of requests for or actual assisted suicides. The National Institute of Mental Health funded the study.
[6July07,, #4074; 5July2007,, DC]