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Meta-Analysis
. 2009 Feb 3;180(3):291-7.
doi: 10.1503/cmaj.081514.

Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies

Corrado Barbui  1 , Eleonora Esposito, Andrea Cipriani
Affiliations
Meta-Analysis

Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies

Corrado Barbui et al. CMAJ. .

Abstract

Background: It is unclear whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressant drugs reduce the risk of suicide in people with depression. We explored the association between exposure to SSRIs and risk of suicide completion or attempt.

Methods: We conducted a systematic review of observational studies that reported completed or attempted suicide in depressed individuals who were exposed to SSRIs compared with those who were not exposed to antidepressants. We assessed the overall risk of completed or attempted suicide.

Results: Eight studies involving more than 200 000 patients with moderate or severe depression were included in the meta-analysis. Although exposure to SSRIs increased the risk of completed or attempted suicide among adolescents (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.51-2.44), the risk was decreased among adults (OR 0.57, 95% CI 0.47-0.70). Among people aged 65 or more years, exposure to SSRIs had a protective effect (OR 0.46, 95% CI 0.27-0.79). Sensitivity analyses did not change these findings. In particular, for studies that used completed suicide as an outcome, exposure to SSRIs was associated with increased risk among adolescents (OR 5.81, 95% CI 1.57-21.51) and decreased risk among adults (OR 0.66, 95% CI 0.52-0.83) and older people (OR 0.53, 95% CI 0.26-1.06).

Interpretation: Based on data from observational studies, use of SSRIs may be associated with a reduced risk of suicide in adults with depression. Among adolescents, use of SSRIs may increase suicidality.

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Figures

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Figure 1: Quality of Reporting of Meta-analysis (QUOROM) flow diagram of studies included in the meta-analysis of the risk of suicide with the use of selective serotonin reuptake inhibitors (SSRIs).
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Figure 2: Random-effect meta-analysis of the risk of suicide attempt and completion associated with the use of selective serotonin reuptake inhibitors compared with no exposure to any antidepressants. *Mean age. Note: CI = confidence interval.
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Figure 3: Metaregression of the effect of age on the log odds ratio for the risk of completed or attempted suicide associated with the use of selective serotonin reuptake inhibitors. Each circle represents 1 study. Circle size reflects the weight of the study in the metaregresison. Slope = –0.37, Q = 74.99, p < 0.001.
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Figure 4: Random-effect meta-analysis of the risk of suicide attempt and completion associated with the use of individual antidepressants compared with no exposure to any antidepressants.
See this image and copyright information in PMC

Comment in

References

    1. Hall WD. How have the SSRI antidepressants affected suicide risk? Lancet 2006;367:1959-62. - PubMed
    1. Moller HJ, Baldwin DS, Goodwin G, et al. Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: consensus statement. Eur Arch Psychiatry Clin Neurosci 2008;258(Suppl 3):3-23. - PubMed
    1. Fergusson D, Doucette S, Glass KC, et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 2005;330:396. - PMC - PubMed
    1. Gunnell D, Saperia J, Ashby D. Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review. BMJ 2005;330: 385. - PMC - PubMed
    1. Laughren T. Memorandum: overview for the December 13 meeting of Psychopharmacologic Drugs Advisory Committee. Food and Drug Administration; 2006. Available: www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4272b1-01-fda.pdf (accessed 2008 Dec. 23).

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