Suicide, depression, and antidepressants

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7488.373 (Published 17 February 2005)
Cite this as: BMJ 2005;330:373

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  1. Andrea Cipriani, research fellow in psychiatry (andrea.cipriani@medicina.univr.it),
  2. Corrado Barbui, lecturer in psychiatry,
  3. John R Geddes, professor of epidemiological psychiatry
  1. Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, 37134 Verona, Italy
  2. Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX

    Patients and clinicians need to balance benefits and harms

    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 placebo or other therapeutic interventions (excluding tricyclics). No increase in risk was seen, however, …

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