Antidepressants and suicide: risk–benefit conundrums

David Healy · Chris J. Whitaker

173 citations0/0 files storedJournal of Psychiatry and Neuroscience

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Suicide and Self-Harm Studies Treatment of Major Depression Bipolar Disorder and Treatment

Abstract

There has been a long-standing controversy about the possibility that selective serotonin reuptake inhibitor (SSRI) antidepressants might induce suicidality in some patients. To shed light on this issue, this paper reviews available randomized controlled trials (RCTs), meta-analyses of clinical trials and epidemiological studies that have been undertaken to investigate the issue further. The original clinical studies raising concerns about SSRIs and suicide induction produced evidence of a dose-dependent link on a challenge-dechallenge and rechallenge basis between SSRIs and both agitation and suicidality. Meta-analyses of RCTs conducted around this time indicated that SSRIs may reduce suicidal ideation in some patients. These same RCTs, however, revealed an excess of suicidal acts on active treatments compared with placebo, with an odds ratio of 2.4 (95; confidence interval 1.6-3.7). This excess of suicidal acts also appears in epidemiological studies. The data reviewed here make it difficult to sustain a null hypothesis that SSRIs do not cause problems in some individuals. Further studies or further access to data are indicated to establish the magnitude of any risk and the characteristics of patients who may be most at risk.

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References

1990Emergence of intense suicidal preoccupation during fluoxetine treatment 2000Symptom Reduction and Suicide Risk in Patients Treated With Placebo in Antidepressant Clinical Trials 1991Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression.1995Antidepressants and suicide 1991Emergence of Self-Destructive Phenomena in Children and Adolescents during Fluoxetine Treatment

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