BMJ  2005;330:373-374 (19 February), doi:10.1136/bmj.330.7488.373

Editorial

Suicide, depression, and antidepressants

Patients and clinicians need to balance benefits and harms

The first 150 words of the full text of this article appear below.

Unipolar depression, one of the most important causes of disability worldwide,¹ is characterised by depressed mood, hopelessness, helplessness, intense feelings of guilt, sadness, low self esteem, thoughts of self harm, and suicide. Up to 15% of patients with unipolar depression eventually commit suicide.² Although clinical guidelines recommend treating moderate to severe depression with antidepressant drugs,³ debate persists on whether some antidepressant drugs, in particular the selective serotonin reuptake inhibitors (SSRIs), cause the emergence or worsening of suicidal ideas in vulnerable patients. New insights on this key issue have been provided by three articles published in this issue.

Fergusson et al conducted a systematic review of published randomised controlled trials comparing SSRIs with either placebo or other active treatments in patients with depression and other clinical conditions.⁴ They found an almost twofold increase in the odds of fatal and non-fatal suicidal attempts in users of SSRIs compared with users of . . . [Full text of this article]

Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, 37134 Verona, Italy (andrea.cipriani@medicina.univr.it)

Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, 37134 Verona, Italy

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX

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This article has been cited by other articles:

• Geddes, J. R., Barbui, C., Cipriani, A. (2009). Risk of suicidal behaviour in adults taking antidepressants. BMJ 339: b3066-b3066 [Full text]  
• Barbui, C., Cipriani, A., Geddes, J. R (2008). Antidepressants and suicide symptoms: compelling new insights from the FDA's analysis of individual patient level data. Evid. Based Ment. Health 11: 34-35 [Full text]  
• Tint, A., Haddad, P. M, Anderson, I. M (2008). The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study. J Psychopharmacol 22: 330-332 [Abstract]  
• Barbui, C. MD, Furukawa, T. A. MD, Cipriani, A. MD (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. CMAJ 178: 296-305 [Abstract] [Full text]  
• Cipriani, A., Geddes, J. R, Barbui, C. (2007). Venlafaxine for major depression. BMJ 334: 215-216 [Full text]  
• Olfson, M., Marcus, S. C., Shaffer, D. (2006). Antidepressant drug therapy and suicide in severely depressed children and adults: a case-control study.. Arch Gen Psychiatry 63: 865-872 [Abstract] [Full text]  
• McHenry, L (2006). Ethical issues in psychopharmacology.. J. Med. Ethics 32: 405-410 [Abstract] [Full text]  
• Cipriani, A. (2005). Forensic database study suggests selective serotonin reuptake inhibitors do not increase the risk of suicide in people taking antidepressants. Evid. Based Ment. Health 8: 113-113 [Full text]  
• Waller, P. C, Evans, S. J W, Beard, K. (2005). Drug safety and regulation. BMJ 331: 4-5 [Full text]  
• Murray, M. L, Wong, I. C K, Thompson, M. (2005). Do selective serotonin reuptake inhibitors cause suicide?: Antidepressant prescribing to children and adolescents by GPs has fallen since CSM advice. BMJ 330: 1151-1151 [Full text]  
• Sakinofsky, I., Streiner, D. L (2005). Do selective serotonin reuptake inhibitors cause suicide?: Let's keep it in perspective. BMJ 330: 1149-1149 [Full text]  
• Mitchell, A. J (2005). Do selective serotonin reuptake inhibitors cause suicide?: Data seem to be incorrect. BMJ 330: 1149-1150 [Full text]  
• Raven, M. K (2005). Do selective serotonin reuptake inhibitors cause suicide?: Suicide rate of 15% in editorial is misleading. BMJ 330: 1150-1150 [Full text]  
• (2005). Do SSRIs Increase Suicide Risk in Adults?. Journal Watch Dermatology 2005: 10-10 [Full text]  
• (2005). Do SSRIs Increase Suicide Risk in Adults?. JWatch General 2005: 6-6 [Full text]  
• (2005). SSRIs and Suicide Risk: A Concern for Adults, Too?. JWatch Psychiatry 2005: 1-1 [Full text]  

Rapid Responses:

Read all Rapid Responses

Misleading statement re 15% suicide

Melissa K Raven
bmj.com, 18 Feb 2005 [Full text]

Decline in antidepressant prescribing to children and adolescents in primary care since UK CSM advice

Macey L Murray, et al.
bmj.com, 18 Feb 2005 [Full text]

Suicide, depression & antidepressants

Peter O'Loughlin
bmj.com, 19 Feb 2005 [Full text]

15%! The figures don't add up.

Andrew J Smith
bmj.com, 19 Feb 2005 [Full text]

Antidepressants and Increased Risk of Suicide

Peter J T Balfour
bmj.com, 22 Feb 2005 [Full text]

No indication for increased rate of suicide attempts by SSRIs in the Netherlands

Richard L Marquet, et al.
bmj.com, 3 Mar 2005 [Full text]

Suicide attempts on drug medications

Ellen C G Grant
bmj.com, 4 Mar 2005 [Full text]

Re: No indication for increased rate of suicide attempts by SSRIs in the Netherlands

John P Heptonstall
bmj.com, 4 Mar 2005 [Full text]

Selective Serotonin Reuptake Inhibitors (SSRIs) and Suicide Fatalities

Raymond Crowe
bmj.com, 24 Mar 2005 [Full text]

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