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suicide: risk-benefit conundrums.
Healy D, Whitaker
Department of Psychological Medicine, University of Wales
College of Medicine, Hergest Unit, Bangor, United Kingdom.
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.
PMID: 14517576 [PubMed - indexed for