BMJ  2005;330:1148-1149 (14 May), doi:10.1136/bmj.330.7500.1148-b

Letter

Do selective serotonin reuptake inhibitors cause suicide?

Authors' reply to Curtin and Schulz, and Healy

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

EDITOR—We agree with Curtin and Schulz that drug induced motor disinhibition before mood improvement is a possible explanation for an excess of suicidal behaviour in the early weeks of antidepressant treatment.^{1 2}

Regarding their second point, we caution against over-interpreting differences in the pooled odds ratios for self harm and suicidal thoughts or the odds ratios for different selective serotonin reuptake inhibitors (SSRIs) in relation to the same end points. Odds ratios are estimated from a small number of events, and confidence intervals overlap.

Lastly, we agree that there is little evidence for a difference in risk between different classes of antidepressant.^3-5

Healy is concerned about two of the numbers in our meta-analysis. We confirm that the expert working group's report included one suicide among patients treated with placebo in placebo controlled trials of citalopram for depression (table 7.16, page 84).⁵ Likewise data on paroxetine suicides were reported (section . . . [Full text of this article]

Department of Social Medicine, University of Bristol, Bristol BS8 2PR D.J.Gunnell@bristol.ac.uk

Wolfson Institute of Preventive Medicine, Queen Mary, University of London, London EC1M 6BQ

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