Suicide and antidepressants

Sinclair, J.M.A. (2005) Suicide and antidepressants. International Journal of Psychiatry in Clinical Practice, 9 (4), 302-302. (doi:10.1080/13651500500360676).

Abstract

The causes of suicide are complex, and our understanding of the processes and pathways leading to suicide is complicated by the limitations of the available data. Suicide is strongly associated with mental illness, especially in patients with significant depressive features, and those with a history of suicidal behaviour. Prevention of suicide both in the general population and in severely mentally ill patients is a feature of health policy initiatives in many countries. However, whilst there is significant evidence for the efficacy of treatment for depressive disorders, a meta-analysis of treatment for the secondary prevention of suicidal behaviour found that few treatments were effective or feasible in practice. Randomised controlled trials, analyses of pooled data, pharmacoepidemiological studies, case series and psychological autopsy studies provide different strands of evidence when examining the question of whether antidepressant drugs might provoke or prevent attempted and completed suicide. Ecological studies consistently show an association between increased antidepressant prescribing and reduction of suicide. Recent pharmacoepidemiological reports found no evidence for an increase in suicide associated with different classes of antidepressant classes, although weak evidence for an increase in suicidal behaviour in young adults prescribed some antidepressants. The challenge for the clinician continues to be the effective management of patients with depressive symptoms and suicidal behaviour, weighing the relative risks and benefits from the evidence available.

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Contributors

Author: J.M.A. Sinclair

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