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Antidepressants and risk of suicide

BMJ 2015; 350 doi: (Published 19 February 2015) Cite this as: BMJ 2015;350:h783
  1. Mark Sinyor, psychiatrist1, assistant professor2,
  2. Amy H Cheung, psychiatrist1, associate professor2
  1. 1Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
  2. 2Department of Psychiatry, University of Toronto, Canada
  1. Correspondence to M Sinyor mark.sinyor{at}

Reported differences among drugs are important to know, but hard to interpret

Suicide is recognized as one of the most urgent public health concerns of our time, with approximately 60% of such deaths attributed to mood disorders.1 Ideally, well designed randomized controlled trials would guide doctors toward the best antidepressant for reducing the risk of suicide (and away from those likely to increase it).

Despite 1.5% of the world’s population dying from suicide,2 these deaths occur throughout the lifespan so risk remains low during any brief period under study. This makes research uniquely challenging. For example, one large meta-analysis of 372 antidepressant trials and nearly 100 000 patients reported a total of just eight suicide deaths.3 Given this, large population based studies are needed to understand better the true impact of antidepressants on patients. Ultimately the combined evidence base from both clinical trials and epidemiological studies should inform clinical decision making.

In a linked paper (doi:10.1136/bmj.h517) Coupland and colleagues conducted a cohort study using a large UK primary care database to quantify associations between different antidepressants and suicide as well as deliberate self harm (including suicide attempts) during the first five years of follow-up for adults with a …

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