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Do SSRIs or antidepressants in general increase suicidality? WPA section on pharmacopsychiatry: consensus statement

Do SSRIs or antidepressants in general increase suicidality? WPA section on pharmacopsychiatry: consensus statement
Do SSRIs or antidepressants in general increase suicidality? WPA section on pharmacopsychiatry: consensus statement
In the past few years several papers have reported critically on the risk of suicidal thoughts and behaviour associated with antidepressants, primarily SSRIs. The risk-benefit ratio of antidepressant (AD) treatment has been questioned especially in children and adolescents. The critical publications led to warnings being issued by regulatory authorities such as the FDA, MHRA and EMEA and stimulated new research activity in this field. However, potential harmful effects of antidepressants on suicidality are difficult to investigate in empirical studies because these have several methodological limitations. Randomised controlled trials (RCTs) are the most reliable way to test the hypothesis that AD have such side effects. In addition to meta-analyses of RCTs, complementary research methods should be applied to obtain the most comprehensive information. We undertook a comprehensive review of publications related to the topics ADs, suicide, suicidality, suicidal behaviour and aggression. Based on this comprehensive review we conclude that ADs, including SSRIs, carry a small risk of inducing suicidal thoughts and suicide attempts, in age groups below 25 years, the risk reducing further at the age of about 30-40 years. This risk has to be balanced against the well-known beneficial effects of ADs on depressive and other symptoms (anxiety, panic, obsessive-compulsive symptoms), including suicidality and suicidal behaviour. According to the principles of good clinical practice, decision making should consider carefully the beneficial effects of AD treatment as well as potentially harmful effects and attempt to keep the potential risks of AD treatment to a minimum. It is the major problem facing efforts to identify the possible 'suicidal effects' of antidepressants
antidepressive agents, randomized controlled trials as topic, epidemiology, adverse effects, drug therapy, consensus, age factors, suicide, chemically induced, humans, depression, self-injurious behavior, pharmacoepidemiology, animals, risk factors, psychology, adolescent, methods
0940-1334
3-23
Moller, Hans-Jürgen
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Baldwin, D. S.
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Goodwin, G.
b8b6eee4-f01c-4a14-a0ef-32d5d0c94d8d
Kasper, S.
d5cfec73-0b6a-4955-a152-8ceef1dcaa1d
Okasha, A.
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Stein, D. J.
ea73ce90-6195-47fa-8583-237c128091b2
Tandon, R.
40459c89-d6dd-4df9-b1fd-0703844b28da
Versiani, M.
dd1a3be6-b8f6-4f5a-aeb2-3687d23cc4da
Moller, Hans-Jürgen
0a342bc0-500e-4488-9393-0a2d74e0e916
Baldwin, D. S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Goodwin, G.
b8b6eee4-f01c-4a14-a0ef-32d5d0c94d8d
Kasper, S.
d5cfec73-0b6a-4955-a152-8ceef1dcaa1d
Okasha, A.
25a7c891-bc6a-4f0d-b241-a5b8e3b623dd
Stein, D. J.
ea73ce90-6195-47fa-8583-237c128091b2
Tandon, R.
40459c89-d6dd-4df9-b1fd-0703844b28da
Versiani, M.
dd1a3be6-b8f6-4f5a-aeb2-3687d23cc4da

Moller, Hans-Jürgen, Baldwin, D. S., Goodwin, G., Kasper, S., Okasha, A., Stein, D. J., Tandon, R. and Versiani, M. (2008) Do SSRIs or antidepressants in general increase suicidality? WPA section on pharmacopsychiatry: consensus statement. European Archives of Psychiatry and Clinical Neuroscience, 258 (Supplement 3), 3-23. (doi:10.1007/s00406-008-3002-1).

Record type: Article

Abstract

In the past few years several papers have reported critically on the risk of suicidal thoughts and behaviour associated with antidepressants, primarily SSRIs. The risk-benefit ratio of antidepressant (AD) treatment has been questioned especially in children and adolescents. The critical publications led to warnings being issued by regulatory authorities such as the FDA, MHRA and EMEA and stimulated new research activity in this field. However, potential harmful effects of antidepressants on suicidality are difficult to investigate in empirical studies because these have several methodological limitations. Randomised controlled trials (RCTs) are the most reliable way to test the hypothesis that AD have such side effects. In addition to meta-analyses of RCTs, complementary research methods should be applied to obtain the most comprehensive information. We undertook a comprehensive review of publications related to the topics ADs, suicide, suicidality, suicidal behaviour and aggression. Based on this comprehensive review we conclude that ADs, including SSRIs, carry a small risk of inducing suicidal thoughts and suicide attempts, in age groups below 25 years, the risk reducing further at the age of about 30-40 years. This risk has to be balanced against the well-known beneficial effects of ADs on depressive and other symptoms (anxiety, panic, obsessive-compulsive symptoms), including suicidality and suicidal behaviour. According to the principles of good clinical practice, decision making should consider carefully the beneficial effects of AD treatment as well as potentially harmful effects and attempt to keep the potential risks of AD treatment to a minimum. It is the major problem facing efforts to identify the possible 'suicidal effects' of antidepressants

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More information

Published date: August 2008
Keywords: antidepressive agents, randomized controlled trials as topic, epidemiology, adverse effects, drug therapy, consensus, age factors, suicide, chemically induced, humans, depression, self-injurious behavior, pharmacoepidemiology, animals, risk factors, psychology, adolescent, methods

Identifiers

Local EPrints ID: 70207
URI: http://eprints.soton.ac.uk/id/eprint/70207
ISSN: 0940-1334
PURE UUID: 30a330b1-848b-48e0-84c1-717cb939365a
ORCID for D. S. Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

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Date deposited: 28 Jan 2010
Last modified: 14 Mar 2024 02:38

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Contributors

Author: Hans-Jürgen Moller
Author: D. S. Baldwin ORCID iD
Author: G. Goodwin
Author: S. Kasper
Author: A. Okasha
Author: D. J. Stein
Author: R. Tandon
Author: M. Versiani

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