Antidepressants--do they decrease or increase suicidality?

Area of Science:

• Psychiatry
• Pharmacology
• Clinical Psychology

Background:

• Antidepressants are widely prescribed for depression.
• Concerns exist regarding their potential influence on suicidality.
• The literature requires synthesis to clarify these effects.

Purpose of the Study:

• To analyze the influence of antidepressants on suicidality.
• To investigate potential differences between antidepressant subgroups regarding suicidality.
• To evaluate the hypothesis of a specific suicidality-increasing risk associated with certain antidepressants.

Main Methods:

• Intensive literature review.
• Analysis of existing studies and clinical hypotheses.
• Examination of control-group study data.

Main Results:

• Antidepressants, in general, demonstrate a reduction in suicidal ideations among depressive patients.
• Evidence for a faster onset of action for serotonin-reuptake inhibitors in reducing suicidal ideation is inconclusive.
• Controlled studies have not confirmed a specific suicidality-increasing risk linked to particular antidepressant classes (e.g., drive-enhancing, non-sedating).

Conclusions:

• Antidepressants are effective in reducing suicidal ideation in depression.
• No specific antidepressant subgroup has been definitively linked to an increased risk of suicidality.
• An unspecific induction of suicidality is rare and associated with predisposing factors like personality disorders or polypharmacy.