Intended for healthcare professionals

Rapid response to:

Primary Care

Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials

BMJ 2005; 330 doi: (Published 17 February 2005) Cite this as: BMJ 2005;330:396

Rapid Response:

Risk of Suicide Using SSRIs: Further Clarification is Required


Perhaps naively, I thought that Fergusson and colleagues might appreciate me highlighting that either their paper contained erroneous data or there had been a miscalculation. Although they have been kind enough to respond to two independent comments, and acknowledge an “error in the odds ratio estimate for fatal attempts in the SSRI versus TCA analysis” I am surprised that that authors have not taken the opportunity to correct this error in their e-response. Specifically, is the error in the raw data (table 1) or in the calculation? In either case what are the correct figures?

If I understand the authors correctly, there is in fact no increased risk of fatal outcomes with SSRIs in this dataset and they wish to correct the “What this study adds” box that “Evidence from this study supports the association between the use of SSRIs and increased risk of fatal and non-fatal suicide attempts” (my highlight)

Whilst accepting the point that weighting should be taken into account, I believe that the substantial differences in the effect sizes I pointed out in my original response require further clarification. I hope the authors will not take offence if I respectfully suggest that the statisticians employed by the BMJ could help by looking at the primary dataset; after all, isn’t that their primary role?

Competing interests:
None declared

Competing interests: No competing interests

09 March 2005
Alex J Mitchell
Consultant in Liaison Psychiatry
Leicester General Hospital