SSRIs may reduce the risk of suicide in depressed adults

Selective serotonin reuptake inhibitors (SSRIs) may reduce the risk of suicide in depressed adults, according to a study by researchers from the World Health Organization and the University of Verona, Italy published in CMAJ.

The study, a meta-analysis of 8 large-scale observational studies, was undertaken to explore whether SSRIs reduce or increase the risk of suicide in depressed people.

Previous studies, including a 2007 study by the U.S. Food and Drug Administration (FDA), found the risk of suicide in adults was neutral, elevated in those under 25 and reduced in people older than 65. A subsequent black box warning was added to all antidepressants regarding increased risk of suicidal symptoms in people under 25 years of age.

"While the FDA analysis found a neutral effect of SSRIs (or a promoting effect in adults aged 18-25), we found a strong protective effect associated with SSRI treatment in adults," Dr. Corrado Barbui and colleagues. SSRIs in adults significantly reduced the risk of completed or attempted suicide.

They conclude "data from observational studies should reassure doctors that prescribing serotonin reuptake inhibitors in patients with major depression is safe," although children and adolescents should be closely monitored due to the possibility of suicidal thoughts and suicide.

In a related commentary http://www.cmaj.ca/press/pg270.pdf, Dr. John Mann of Columbia University and Dr. Robert Gibbons of the University of Illinois write "alarmingly, concerns about the risk of suicide in youth have led not only to fewer SSRI prescriptions without substitution of alternative medications or psychotherapies, but also to a decrease in predicted rates of diagnosis of mood disorders." They suggest doctors may be avoiding making diagnoses and call for randomized controlled trials to determine safety and efficacy of treatments for young adults.