Risk of suicidality in depression with serotonergic antidepressants.
Since depression is a risk factor for suicidal thoughts and behaviors, and since suicidal behaviors are associated with low serotonin activity, are selective serotonin reuptake inhibitors (SSRIs) more effective than other antidepressants in treating suicidality in depressed patients? There is inconclusive evidence for and against this hypothesis. However, all studies suggest that antidepressants are effective treatments of suicidal ideations and behaviors, and SSRIs have been shown to have prophylactic effects in preventing suicidal behaviors. Although some reports suggest that SSRIs might increase suicidal ideations and behaviors, the results of large, double-blind studies do not suggest a causal relationship between pharmacotherapy and the emergence of suicidality. Undertreatment of depression and therapeutic failure are more significant problems with the use of antidepressants in suicidal patients than the risk of using antidepressants in overdose. Prescribing inadequate doses of antidepressants is therefore a source of overlooked risk.
Matthews
J D
JD
Department of Psychiatry, Massachusetts General Hospital, Boston 02114, USA. jmatthews@partners.org
Fava
M
M
D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D004565:Electroconvulsive Therapy; D006801:Humans; D018570:Risk Assessment; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors