Franklin James Cook

Study Shows SSRIs Lower Adult Suicide; Teens, SSRIs Debated

In Research on February 10, 2009 at 6:38 pm

ORIGINAL REPORT — A report today in Science Daily briefly summarizes a study by researchers from the World Health Organization and the University of Verona, Italy that is published in the current issue of the Canadian Medical Association Journal, which says that “SSRIs [selective serotonin reuptake inhibitors] in adults significantly reduced the risk of completed or attempted suicide” [SPNAC readers can access the full text of the CMAJ article].

The study, a meta-analysis of 8 large-scale observational studies, was undertaken to explore whether SSRIs reduce or increase the risk of suicide in depressed people.

Previous studies, including a 2007 study by the U.S. Food and Drug Administration (FDA), found the risk of suicide in adults was neutral, elevated in those under 25 and reduced in people older than 65. A subsequent black box warning was added to all antidepressants regarding increased risk of suicidal symptoms in people under 25 years of age.

“While the FDA analysis found a neutral effect of SSRIs (or a promoting effect in adults aged 18-25), we found a strong protective effect associated with SSRI treatment in adults,” [according to] Dr. Corrado Barbui and colleagues.

The WHO/Verona study also concludes that “for studies that used completed suicide as an outcome, exposure to SSRIs was associated with increased risk among adolescents,” and the current issue of CMAJ also features a companion piece [SPNAC readers can access the full text] to the report about the SSRI study, which  focuses on a key issue regarding the FDA’s warning and SSRI use among young people:

Evidence of a possible association between the use of selective serotonin reuptake inhibitors (SSRIs) and suicide in youth presents a vexing problem for clinicians, youth and their families … Do SSRIs carry a greater risk for suicide than no treatment or alternative treatments such as other antidepressants or specific psychotherapies?

The commentary is written by Dr. John Mann of Columbia University and Dr. Robert Gibbons of the University of Illinois, who state “alarmingly, concerns about the risk of suicide in youth have led not only to fewer SSRI prescriptions without substitution of alternative medications or psychotherapies, but also to a decrease in predicted rates of diagnosis of mood disorders.”

With so many uncertainties, large randomized trials are now required … Studies of SSRIs that include suicidal adolescents with major depression are urgently needed to determine the safety and efficacy of these medications.

The FDA’s information on SSRIs includes a medication guide covering antidepressants and suicide that lists the most important information a person should know on the topic:

  1. Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults when the medicine is first started.
  2. Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness also called manic-depressive illness) or suicidal thoughts or actions.
  3. [Know] how … [to] watch for and … prevent suicidal thoughts and actions …

The medication guide (SPNAC readers may download a copy) goes on to elaborate on the signs to “watch for” and the action to take if they appear (namely “call a healthcare provider right away”).

[Editor’s note: In addition to calling for assistance, one should also not leave the person alone and help keep the person safe from harm (for instance, by removing his or her access to lethal means if it is not dangerous to do so). If you or someone you know feels suicidal, please click on NEED HELP?]

[The abridged URL for this post is .]

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