summary
background There is considerable controversy about the possible link between suicidal behaviour and antidepressants. Since ethical and methodological problems prevent direct research, discussion has to draw largely on indirect evidence.
aim To review randomised controlled trials (rcts), observational studies, ecological studies and recommendations of the Food and Drug Administration (fda) regarding the risk of suicidality linked to the use of ssris.
method We summarised and reviewed critically the literature on suicidality and ssris via the PubMed database up till March 2008.
results Various analyses, most of which were meta-analyses, showed that in adults ssris increase the risk of suicidal ideation and suicide attempts. However, neither observational studies nor the findings of the fda gave any indication of an increased risk of suicide in adults being treated with ssris. On the other hand, if patients were on antidepressants, the younger they were, the greater was the risk of suicidal thoughts or suicide attempts. Children, adolescents and young adults who were on ssris ran an increased risk of suicidal ideation and suicide attempts. One observational study did not show this association.
conclusion Treatment with ssris does not increase the risk of suicide in adults, but it is difficult to make a firm pronouncement about the effect of ssris on suicidal behaviour (ideation and suicide attempts). However, in children, adolescents and young adults being treated with ssris, there is an increased risk of attempted suicide.