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Research

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

Corrado Barbui, Eleonora Esposito and Andrea Cipriani
CMAJ February 03, 2009 180 (3) 291-297; DOI: https://doi.org/10.1503/cmaj.081514
Corrado Barbui MD
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Eleonora Esposito MD
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Andrea Cipriani MD
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    Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies

    Corrado Barbui MD, Eleonora Esposito MD, Andrea Cipriani MD

    Contexte : On ignore si l’utilisation des inhibiteurs sélectifs du recaptage de la sérotonine (ISRS) et d’autres antidépresseurs réduit le risque de suicide chez les personnes qui souffrent de dépression. Nous avons analysé le lien entre l’exposition à des ISRS et le risque de suicide ou de tentative de suicide.

    Méthodes : Nous avons procédé à une revue systématique des études d’observation faisant état de suicides ou de tentatives de suicide chez des sujets déprimés ayant été exposés à des ISRS, comparativement à des sujets n’ayant pas pris d’antidépresseurs. Nous avons évalué le risque global de suicide et de tentative de suicide.

    Résultats : Huit études regroupant plus de 200 000 patients atteints de dépression modérée ou grave ont servi de base à la méta-analyse. Si l’exposition aux ISRS a contribué à faire augmenter le risque de suicide ou de tentative de suicide chez les adolescents (rapport des cotes RC 1,92; intervalle de confiance IC à 95 %, 1,51–2,44), le risque a été moindre chez les adultes (RC 0,57; IC à 95 %, 0,47–0,70). Parmi les 65 ans ou plus, l’exposition à des ISRS a exercé un effet protecteur (RC 0,46; IC à 95 %, 0,27–0,79). Les analyses de sensibilité n’ont pas modifié ces observations. À noter, dans le cas des études qui portaient sur le suicide en tant que paramètre, l’exposition aux ISRS a été associée à un risque accru chez les adolescents (RC 5,81; IC à 95 %, 1,57–21,51) et à un risque moindre chez les adultes (RC 0,66; IC à 95 %, 0,52–0,83) et les sujets plus âgés (RC 0,53; IC à 95 %, 0,26–1,06).

    Interprétation : Selon des données tirées d’études d’observation, l’utilisation des ISRS serait associée à un risque moindre de suicide chez les adultes souffrant de dépression. Parmi les adolescents, l’utilisation des ISRS pourrait accroître la tendance suicidaire.

    Affiliations : 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

    Correspondance : 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

    • Online Appendices

      Files in this Data Supplement:

      • Appendix 1: A proposed reporting checklist for authors, editors, and reviewers of meta-analyses of observational studies (MOOSE checklist)
      • Appendix 2: search strategy
      • Appendix 3: Data Abstraction Form for Systematic Review of SSRIs and Suicide
      • Appendix 4: Quality Checklist for Systematic Review of SSRIs and Suicide
      • Appendix 5: Characteristics of included studies assessing the relationship between SSRI exposure and risk of suicide attempt and completion
      • Appendix 6: Funnel plot investigating the possibility of publication bias
      • Appendix 7: Random-effect meta-analysis influence test that eliminated each of the included studies at a time

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    Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies
    Corrado Barbui, Eleonora Esposito, Andrea Cipriani
    CMAJ Feb 2009, 180 (3) 291-297; DOI: 10.1503/cmaj.081514

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    Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies
    Corrado Barbui, Eleonora Esposito, Andrea Cipriani
    CMAJ Feb 2009, 180 (3) 291-297; DOI: 10.1503/cmaj.081514
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