Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressant, yet concerns have arisen that these drugs may induce or worsen suicidal feelings in vulnerable patients.

Three studies published in this issue shed new light on the benefits and harms of these drugs.

In the first study, researchers analysed 702 trials involving over 87,000 patients with depression and other clinical conditions to establish whether a link exists between use of SSRIs and suicide attempts.

They found that patients taking SSRIs were twice as likely to attempt suicide compared with patients taking placebo. However, no increase in risk was seen when only fatal suicidal attempts were compared between SSRIs and placebo. Finally, they found no difference between patients taking SSRIs and those taking other drugs, known as tricyclic antidepressants.

The authors point out that, while the absolute risk of suicide is low, the widespread use of SSRIs makes this a population health concern. They also warn that major limitations in the published trials may have led to underestimates of the risk of suicide attempts.

The second study reviewed 477 trials submitted by drug companies to the safety review of the Medicines and Healthcare products Regulatory Agency (MHRA). These trials compared SSRIs with placebo in adults with depression and other clinical conditions.

The research team found no evidence that SSRIs increased the risk of suicide. They found weak evidence of an increased risk of self harm, but no evidence of an increased risk of suicidal thoughts.

Increased risks of suicide and self harm caused by SSRIs cannot be ruled out, say the authors, but larger trials with longer monitoring periods are needed to assess the balance o
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
17-Feb-2005