Variation in the Risk of Suicide Attempts and Completed Suicides by Antidepressant Agent in Adults

Abstract

Despite the widespread use of antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs), there is inconsistent evidence that growth in antidepressant use has reduced the prevalence of suicidal ideation or suicide attempts during the past decade.^1-3 In October 2004, the US Food and Drug Administration issued an advisory that antidepressants may be associated with an increased risk of suicidal thoughts and behaviors in children and adolescents.⁴ These warnings were prompted by a meta-analysis of all available randomized trials of antidepressants in this age group, in which patients randomized to antidepressants had nearly twice the rate of suicidal ideation or behavior relative to those given placebo.⁵ These concerns prompted the US Food and Drug Administration to undertake a reanalysis of all its available antidepressant trials in adults as well. This meta-analysis and several subsequent analyses of short-term trials found no increased risk of suicidality in adult antidepressant users.^6-9 However, the interpretation of this meta-analysis is limited by a number of factors including the brief duration of trials, few suicide attempts and almost no completed suicides, varying definitions of suicidality, noncomparable doses, and heterogeneous patient mixes.