Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: Consensus statement

Hans Jürgen Möller, David S. Baldwin, Guy Goodwin, Siegfried Kasper, Ahmed Okasha, Dan J. Stein, Rajiv Tandon, Marcio Versiani, Ulrik Malt, Bernd Saletu, A. Carlo Altamura, David Baron, Michael Bauer, R. H. Belmaker, Pierre Blier, Patrice Boyer, William E. Bunney, Graham Burrows, Wolfang Fleischhacker, Daniel FloresWagner F. Gattaz, Gerardo Heinze, Ian Hindmarch, Hans Hippius, Cyril Hoschl, Per Kragh-Sorensen, Juan J. Lopez-Ibor, Bruno Millet, Sung Kil Min, Jaime Monti, Bruno Muller-Oerlinghausen, Franz Muller-Spahn, David J. Nutt, Jean Pierre Olie, Eugene S. Paykel, Giorgio Racagni, Perry Renshaw, Raben Rosenberg, Bruce Singh, Eduard Vieta, Joseph Zohar

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)3-23
Number of pages21
JournalEuropean Archives of Psychiatry and Clinical Neuroscience
Volume258
Issue numberSUPPL.3
DOIs
Publication statusPublished - Aug 2008

Keywords

  • Antidepressants
  • Suicidal behaviour
  • Suicidality
  • Suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Neuropsychology and Physiological Psychology
  • Clinical Neurology

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    Möller, H. J., Baldwin, D. S., Goodwin, G., Kasper, S., Okasha, A., Stein, D. J., Tandon, R., Versiani, M., Malt, U., Saletu, B., Altamura, A. C., Baron, D., Bauer, M., Belmaker, R. H., Blier, P., Boyer, P., Bunney, W. E., Burrows, G., Fleischhacker, W., ... Zohar, J. (2008). Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: Consensus statement. European Archives of Psychiatry and Clinical Neuroscience, 258(SUPPL.3), 3-23. https://doi.org/10.1007/s00406-008-3002-1