BMJ  2005;330:1148 (14 May), doi:10.1136/bmj.330.7500.1148

Letter

Do selective serotonin reuptake inhibitors cause suicide?

Risk of suicide should be assessed for whole class of antidepressants

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

EDITOR—Gunnell et al's report on suicide risk with selective serotonin reuptake inhibitors (SSRIs) raises several issues.¹

Firstly, clinicians have observed that the first weeks of treatment of severe depression with an antidepressant are accompanied by a higher risk of suicide because of a drug induced motor disinhibition that is not yet accompanied by mood improvement.²

Secondly, the authors' finding of a trend towards a protective effect of SSRIs against suicidal thoughts (odds ratio 0.77) compared with a trend towards an increased risk of self harm (odds ratio 1.57) is paradoxical.

More surprising is the heterogeneity of results among SSRIs. Why would sertraline show a protective effect for suicidal thoughts and simultaneously increase the risk of self harm? The risk difference between citalopram and its active S-enantiomere, escitalopram, is also strange. No strong biological rationale can explain such heterogeneity among drugs with the same mechanism of action.

Thirdly, the . . . [Full text of this article]

francoiscurtin@bluemail.ch
Clinical Psychopharmacology Unit, University of Geneva, 2 Ave du Petit-Bel-Air, CH-1225 Chene-Bourg/Geneva, Switzerland

Clinical Psychopharmacology Unit, University of Geneva, 2 Ave du Petit-Bel-Air, CH-1225 Chene-Bourg/Geneva, Switzerland

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