Amy Cheung, MD, MSc
What is the risk for completed or attempted suicide by age group in persons with depression who have used selective serotonin reuptake inhibitors (SSRIs)?
Included studies were cohort or case–control studies that provided data for completed or attempted suicide among persons who had major depression and received SSRIs and those who had not used SSRIs. Outcomes were completed or attempted suicide (International Classification of Disease, 9th or 10th revision). Preparatory acts toward imminent suicidal behaviors, suicidal ideation, and self-injurious behavior (intent unknown) were not included.
MEDLINE, EMBASE/Excerpta Medica, and reference lists (1990 to Jun 2008) were searched for studies. 8 studies (6 cohort studies, 2 case–control studies) met the selection criteria. Study quality scores ranged from 6 to 8 with a mean of 7 (10-point scale; high-quality studies scored ≥ 7). Results were pooled using a random-effects model.
Use of SSRIs was associated with an increased risk for completed or attempted suicide in adolescents but not in adults or elderly persons (Table). In adults, no individual drug was associated with increased risk; in adolescents, paroxetine and venlafaxine were associated with increased suicide risk (Table).
Exposure to selective serotonin reuptake inhibitors in depressed persons was associated with an increased risk for completed or attempted suicide in adolescents but not in adults or elderly persons.
Associations between SSRIs and suicide in depression*
*SSRI = selective serotonin reuptake inhibitor.
†Pooled using a random-effects model.
Cheung A. Review: SSRIs are associated with increased risk for attempted or completed suicide in adolescents but not in adults or the elderly. Ann Intern Med. 2009;150:JC6–13. doi: 10.7326/0003-4819-150-12-200906160-02013
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Published: Ann Intern Med. 2009;150(12):JC6-13.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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