Antidepressants--do they decrease or increase suicidality?

Abstract

Based on an intensive review of the literature, the question was analyzed as to whether antidepressants have an influence on suicidality and whether there are specific differences between certain subgroups of antidepressants. In general, antidepressants reduce suicidal ideations in depressive patients. A faster onset of this kind of action in serotonin-reuptake inhibitors is not yet completely proved. The hypothesis, described by clinicians, of a specific suicidality-increasing risk being associated with a certain group of antidepressants (e.g., antidepressants with a drive-enhancing, non-sedating clinical profile, drugs with a certain biochemical mode of action) has hitherto not been confirmed in control-group studies. An unspecific induction of suicidality, observable also under other psychoactive drugs, appears to be quite rare and occurs only under predisposing conditions, such as personality disorders and comedication with other drugs.