CMAJ • February 3, 2009; 180 (3). doi:10.1503/cmaj.081514.
© 2009 Canadian Medical Association or its licensors
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Research

Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies

Corrado Barbui, MD, Eleonora Esposito, MD and Andrea Cipriani, MD

From the World Health Organization Collaborating Centre for Research and Training in Mental Health, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy

Correspondence to: Dr. Corrado Barbui, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Policlinico GB Rossi, Piazzale Scuro 10, 37134 Verona, Italy; fax 39 045-8027498; corrado.barbui{at}univr.it

Background: It is unclear whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressant drugs reduce the risk of suicide in people with depression. We explored the association between exposure to SSRIs and risk of suicide completion or attempt.

Methods: We conducted a systematic review of observational studies that reported completed or attempted suicide in depressed individuals who were exposed to SSRIs compared with those who were not exposed to antidepressants. We assessed the overall risk of completed or attempted suicide.

Results: Eight studies involving more than 200 000 patients with moderate or severe depression were included in the meta-analysis. Although exposure to SSRIs increased the risk of completed or attempted suicide among adolescents (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.51–2.44), the risk was decreased among adults (OR 0.57, 95% CI 0.47–0.70). Among people aged 65 or more years, exposure to SSRIs had a protective effect (OR 0.46, 95% CI 0.27–0.79). Sensitivity analyses did not change these findings. In particular, for studies that used completed suicide as an outcome, exposure to SSRIs was associated with increased risk among adolescents (OR 5.81, 95% CI 1.57–21.51) and decreased risk among adults (OR 0.66, 95% CI 0.52–0.83) and older people (OR 0.53, 95% CI 0.26–1.06).

Interpretation: Based on data from observational studies, use of SSRIs may be associated with a reduced risk of suicide in adults with depression. Among adolescents, use of SSRIs may increase suicidality.


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Proper studies of selective serotonin reuptake inhibitors are needed for youth with depression
Robert Gibbons, PhD and J. John Mann, MD
Can. Med. Assoc. J. 2009 180: 270-271. [Full Text] [PDF]



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R. Gibbons PhD and J. J. Mann MD
Proper studies of selective serotonin reuptake inhibitors are needed for youth with depression
Can. Med. Assoc. J., February 3, 2009; 180(3): 270 - 271.
[Full Text] [PDF]

eLetters:

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Age-related risks of suicidal behavior during antidepressant treatment
Ross J Baldessarini, MD
CMAJ, 9 Feb 2009 [Full text]
Adolescents dying by suicide are not taking SSRIs
Michael J Dudley
CMAJ, 17 Mar 2009 [Full text]