Controversies on prevention, provocation, and self poisoning continue

Antidepressants are mostly prescribed for depression and its complications. Foremost among these is suicide, but, despite these drugs having been available for over 35 years, no unequivocal evidence that they prevent suicide exists. Ironically, some antidepressants have been alleged to provoke self destructive behaviour, and patients sometimes kill themselves with the drugs prescribed to treat their depression.

Antidepressant drugs are more effective than placebo in treating acute episodes of affective disorders, and they may help prevent relapses and recurrences of depression. Although they also decrease the score on the “suicide item” on the Hamilton rating scale for depression, this is not a valid measure of suicidal intent or a predictor of future self destruction. Suicide is rare, and small differences in suicide rates during treatment with different antidepressants could be due to chance or unsatisfactory matching between groups. Thus, saying that antidepressants prevent suicide could be more a statement of faith than of fact.

Depression has long been considered to be an uncommon paradoxical adverse reaction to antidepressants.1 Maprotiline has been thought to provoke suicide in some patients because a controlled trial found that more suicides occurred in patients receiving the drug than in those receiving placebo (although the difference was not significant).2 Significantly more suicidal attempts or gestures occurred in the group given maprotiline, but populations who show such …