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

Corrado Barbui1, Eleonora Esposito, Andrea Cipriani

  • 1World Health Organization Collaborating Centre for Research and Training in Mental Health, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
|February 4, 2009
PubMed
Abstract

Insights

Selective serotonin reuptake inhibitors (SSRIs) may reduce suicide risk in adults with depression but increase suicidality in adolescents. This systematic review analyzed SSRI exposure and suicide completion or attempt risks.

Area of Science:

  • Psychiatry
  • Pharmacology
  • Epidemiology

Background:

  • The association between antidepressant use and suicide risk in depression remains unclear.
  • Selective serotonin reuptuptake inhibitors (SSRIs) are commonly prescribed for depression.
  • This study investigates the link between SSRI exposure and suicide completion or attempt.

Purpose of the Study:

  • To explore the association between SSRI exposure and the risk of suicide completion or attempt in individuals with depression.
  • To differentiate the effects of SSRIs on suicidality across different age groups.

Main Methods:

  • A systematic review and meta-analysis of observational studies.
  • Inclusion of studies reporting suicide completion or attempt in depressed individuals exposed to SSRIs versus those not exposed.
  • Assessment of overall risk of completed or attempted suicide.

Main Results:

  • Analysis of eight studies with over 200,000 patients.
  • SSRIs increased suicide risk in adolescents (OR 1.92) but decreased it in adults (OR 0.57) and older adults (OR 0.46).
  • Sensitivity analyses confirmed findings, with notable increased risk in adolescent suicide completion (OR 5.81).

Conclusions:

  • SSRI use may be associated with reduced suicide risk in adults with depression.
  • Adolescent use of SSRIs may be linked to an increased risk of suicidality.
  • Findings highlight age-specific effects of SSRIs on suicide risk in depression.

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