BMJ  2005;330:1149 (14 May), doi:10.1136/bmj.330.7500.1149-a

Letter

Do selective serotonin reuptake inhibitors cause suicide?

Let's keep it in perspective

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

EDITOR—The news media's preoccupation with whether antidepressants provoke suicidal behaviour has generated apprehension in the general public, and clinicians increasingly see patients resistant to taking selective serotonin reuptake inhibitors (SSRIs) even though they might benefit. The meta-analysis by Fergusson et al reported an excess of suicidal attempts with SSRIs v placebo and, initially, an alarming sevenfold odds ratio for fatalities compared with tricyclic antidepressants [subsequently corrected to 1.08 (0.28 to 4.09), see correction 19 March, p 653].¹

A statistical excess of suicidal attempts in studies of SSRIs v placebo has been previously reported and was reasonably explained in the accompanying editorial by Cipriani et al.^{2 3} However, the whole debate loses sight of the fact that the underlying trials were never designed to assess suicidality as an outcome but to satisfy regulatory agencies about efficacy. Retrospective counts of incidents of deliberate self harm or attempted suicide are extremely . . . [Full text of this article]

University of Toronto, CAMH-Clarke Site, 250 College Street, Toronto, ON, Canada M5T 1R8 isaac.sakinofsky@utoronto.ca

Kunin-Lunenfeld Applied Research Unit, Baycrest Centre for Geriatric Care, Toronto, ON, Canada M6A 2E1

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