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Do SSRIs or antidepressants in general increase suicidality?

WPA Section on Pharmacopsychiatry: consensus statement

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European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

In the past few years several papers have reported critically on the risk of suicidal thoughts and behaviour associated with antidepressants, primarily SSRIs. The risk-benefit ratio of antidepressant (AD) treatment has been questioned especially in children and adolescents. The critical publications led to warnings being issued by regulatory authorities such as the FDA, MHRA and EMEA and stimulated new research activity in this field. However, potential harmful effects of antidepressants on suicidality are difficult to investigate in empirical studies because these have several methodological limitations. Randomised controlled trials (RCTs) are the most reliable way to test the hypothesis that AD have such side effects. In addition to meta-analyses of RCTs, complementary research methods should be applied to obtain the most comprehensive information. We undertook a comprehensive review of publications related to the topics ADs, suicide, suicidality, suicidal behaviour and aggression. Based on this comprehensive review we conclude that ADs, including SSRIs, carry a small risk of inducing suicidal thoughts and suicide attempts, in age groups below 25 years, the risk reducing further at the age of about 30–40 years. This risk has to be balanced against the well-known beneficial effects of ADs on depressive and other symptoms (anxiety, panic, obsessive-compulsive symptoms), including suicidality and suicidal behaviour. According to the principles of good clinical practice, decision making should consider carefully the beneficial effects of AD treatment as well as potentially harmful effects and attempt to keep the potential risks of AD treatment to a minimum. It is the major problem facing efforts to identify the possible ‘suicidal effects’ of antidepressants.

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Acknowledgements

This supplement was printed with a support of unrestricted grants by the following pharmaceutical companies: Lilly Deutschland GmbH, Germany; Lundbeck GmbH, Germany; Wyeth Pharma GmbH, Germany. The financial support was granted after the document was finished as regards content and therefore had no influence on the content. The support was solely granted for the printing of the supplement for Eur Arch Psychiatry Clin Neurosci.

Conflict of interest: financial disclosure statement This statement was independently developed by the Section of Pharmacopsychiatry (Chair: Hans-Juergen Moeller) of the World Psychiatric Association. While fully endorsed by the Section, the statement does not purport to be an official document of the Association. Whereas the 42 members of the Section have varying degrees of potential conflicts of interest, relevant disclosure of the eight authors is provided herein. Dr Moeller has received grants or is a consultant for and on the speakership bureaus of AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Novartis, Organon, Pfizer, Sanofi-Aventis, Sepracor, and Wyeth. Dr Baldwin has acted as a consultant to a number of companies with an interest in anxiety and depressive disorders (Asahi, Cephalon, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Pfizer, Pharmacia, Pierre Fabre, Roche, Servier, Sumitomo, Wyeth) and holds or has held research grants (on behalf of the University of Southampton) from a number of companies with an interest in anxiety and depressive disorders (Cephalon, Eli Lilly, GlaxoSmithKline, Lundbeck, Organon, Pfizer, Pharmacia, Roche, Wyeth. Dr Goodwin holds grants from Baily Thomas Charity, MRC, Stanley MRI, Sanofi-Aventis and Servier, has received honoraria for speaking from AstraZeneca, Bristol-Myers Squibb, Eisai, Lundbeck, Sanofi-Aventis, Servier and advice from AstraZeneca, Bristol-Myers Squibb, Lilly, Lundbeck, P1Vital, Sanofi-Aventis, Servier, Wyeth. Dr Kasper received grants/research support, consulting fees and honoraria within the last three years from AstraZeneca, Bristol-Myers Squibb, CSC, Eli Lilly, GlaxoSmithKline, Janssen Pharmaceutica, Lundbeck, MSD, Novartis, Organon, Pierre Fabre, Pfizer, Schwabe, Sepracor, Servier, Wyeth. Dr. Stein has received research grants and/or consultancy honoraria from Astrazeneca, Eli-Lilly, GlaxoSmithKline, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Tikvah, and Wyeth. Dr Versiani received, in the last three years, fees for consultation, participation in advisory boards and/or research grants, from the following companies or institutions: CNPq (Conselho Nacional de Pesquisas), Universidade Federal do Rio de Janeiro, Pfizer, Organon, Servier, Janssen, Astra Zeneca. Drs. Okasha and Tandon report no current conflicts relevant to this article.

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  1. Department of Psychiatry, Ludwig-Maximilians-University München, Nussbaumstrasse 7, 80336, Munich, Germany

    Hans-Jürgen Möller, David S. Baldwin, Guy Goodwin, Siegfried Kasper, Ahmed Okasha, Dan J. Stein, Rajiv Tandon & Marcio Versiani

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  1. Hans-Jürgen Möller
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WPA Section on Pharmacopsychiatry: Hans-Jürgen Möller (Section Chairman); Ulrik Malt (Section Secretary); Bernd Saletu (Section Treasurer), A. Carlo Altamura, David S. Baldwin, David Baron, Michael Bauer, R.H. Belmaker, Pierre Blier, Patrice Boyer, William E. Bunney, Graham Burrows, Wolfang Fleischhacker, Daniel Flores, Wagner F. Gattaz, Guy Goodwin, Gerardo Heinze, Ian Hindmarch, Hans Hippius, Cyril Hoschl, Siegfried Kasper, Per Kragh-Sorensen, Juan J. Lopez-Ibor, Ulrik Malt, Bruno Millet, Sung Kil Min, Jaime Monti, Bruno Muller-Oerlinghausen, Franz Muller-Spahn, David J. Nutt, Ahmed Okasha, Jean Pierre Olie, Eugene S. Paykel, Giorgio Racagni, Perry Renshaw, Raben Rosenberg, Bruce Singh, Dan J. Stein, Rajiv Tandon, Marcio Versiani, Eduard Vieta, Joseph Zohar

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Möller, HJ., Baldwin, D.S., Goodwin, G. et al. Do SSRIs or antidepressants in general increase suicidality?. Eur Arch Psychiatry Clin Neurosci 258 (Suppl 3), 3–23 (2008). https://doi.org/10.1007/s00406-008-3002-1

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