title: Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials.
abstract: 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.
authors.affiliation: Ottawa Health Research Institute, Clinical Epidemiology Program, 501 Smyth Road, Box 201, Ottawa, Ontario, Canada K1H 8L6. dafergusson@ohri.ca
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.forename: Steve
authors.initials: S
authors.lastname: Doucette
authors.forename: Kathleen Cranley
authors.initials: KC
authors.lastname: Glass
authors.forename: Stan
authors.initials: S
authors.lastname: Shapiro
authors.forename: David
authors.initials: D
authors.lastname: Healy
authors.forename: Paul
authors.initials: P
authors.lastname: Hebert
authors.forename: Brian
authors.initials: B
authors.lastname: Hutton
mesh_terms: 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*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
references.citation: Control Clin Trials. 1987 Mar;8(1):12-9
references.pmid: 3568692
references.citation: Int Clin Psychopharmacol. 1991 Dec;6 Suppl 3:49-55; discussion 55-6
references.pmid: 1839632
references.citation: Am J Psychiatry. 2003 Apr;160(4):790-2
references.pmid: 12668373
references.citation: Cochrane Database Syst Rev. 2000;(4):CD002791
references.pmid: 11034764
references.citation: J Fam Pract. 1994 Jan;38(1):49-57
references.pmid: 8289052
references.citation: JAMA. 2004 Jul 21;292(3):338-43
references.pmid: 15265848
references.citation: Lancet. 2004 Apr 24;363(9418):1341-5
references.pmid: 15110490
references.citation: Am Fam Physician. 1997 Jan;55(1):249-54, 259-60
references.pmid: 9012282
references.citation: J Clin Psychiatry. 1991 Dec;52(12):491-3
references.pmid: 1752848
references.citation: BMJ. 1994 Nov 12;309(6964):1286-91
references.pmid: 7718048
references.citation: Am J Psychiatry. 1990 Feb;147(2):207-10
references.pmid: 2301661
references.citation: N Engl J Med. 1991 Feb 7;324(6):420
references.pmid: 1987466
references.citation: J Psychiatry Neurosci. 2003 Sep;28(5):331-7
references.pmid: 14517576
references.citation: N Engl J Med. 1995 Jun 8;332(23):1529-34
references.pmid: 7739706
references.citation: Prim Care Companion J Clin Psychiatry. 2001 Dec;3(6):232-235
references.pmid: 15014590
references.citation: Cochrane Database Syst Rev. 2000;(2):CD001851
references.pmid: 10796826