Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials.
OBJECTIVE
To establish whether an association exists between use of selective serotonin reuptake inhibitors (SSRIs) and suicide attempts.


METHODS
Systematic review of randomised controlled trials.


METHODS
Medline and the Cochrane Collaboration's register of controlled trials (November 2004) for trials produced by the Cochrane depression, anxiety, and neurosis group.


METHODS
Studies had to be randomised controlled trials comparing an SSRI with either placebo or an active non-SSRI control. We included clinical trials that evaluated SSRIs for any clinical condition. We excluded abstracts, crossover trials, and all trials whose follow up was less than one week.


RESULTS
Seven hundred and two trials met our inclusion criteria. A significant increase in the odds of suicide attempts (odds ratio 2.28, 95% confidence 1.14 to 4.55, number needed to treat to harm 684) was observed for patients receiving SSRIs compared with placebo. An increase in the odds ratio of suicide attempts was also observed in comparing SSRIs with therapeutic interventions other than tricyclic antidepressants (1.94, 1.06 to 3.57, 239). In the pooled analysis of SSRIs versus tricyclic antidepressants, we did not detect a difference in the odds ratio of suicide attempts (0.88, 0.54 to 1.42).


CONCLUSIONS
Our systematic review, which included a total of 87 650 patients, documented an association between suicide attempts and the use of SSRIs. We also observed several major methodological limitations in the published trials. A more accurate estimation of risks of suicide could be garnered from investigators fully disclosing all events.
Fergusson
Dean
D
Ottawa Health Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Box 201, Ottawa, Ontario, Canada K1H 8L6. dafergusson@ohri.ca
Doucette
Steve
S
Glass
Kathleen Cranley
KC
Shapiro
Stan
S
Healy
David
D
Hebert
Paul
P
Hutton
Brian
B
D000328:Adult; D000368:Aged; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
D017367:Selective Serotonin Reuptake Inhibitors
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