Intended for healthcare professionals


Selective serotonin reuptake inhibitors

BMJ 2004; 329 doi: (Published 07 October 2004) Cite this as: BMJ 2004;329:809
  1. John R Geddes (, professor of epidemiological psychiatry,
  2. Andrea Cipriani (, research fellow in psychiatry
  1. University of Oxford, Warneford Hospital, Oxford OX10 0RU
  2. Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy

    Remain useful drugs which need careful monitoring

    The increasing use of antidepressants—particularly the selective serotonin reuptake inhibitors (SSRIs)—might be grounds for optimism because it might indicate that one of the great health problems of our age is increasingly being recognised and treated. Instead SSRIs have become embroiled in controversy over both their effectiveness and safety. As well as the doubts about efficacy, the media have fuelled concern that SSRIs may cause serious adverse effects, ranging from worsening depression to suicide. The scientific evidence shows that the media has blown the risk of suicide out of proportion.

    The increase in prescribing of SSRIs has coincided with a fall in the suicide rate in many countries, implying that SSRIs are not a major cause of suicide.1 Case-control studies—which cannot completely rule out confounding by indication—probably exclude a substantial increase in both relative and absolute risk of suicide.2 A meta-analysis of individual patient data from the randomised trials is clearly necessary but has not been done. Short term randomised trials of SSRIs in children and adolescents show a modest increase in some suicidal thoughts and behaviours, but it is …

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