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, …