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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:

SSRI's, why are we surprised?

I wonder how many of these subjects were Hypogonadal, either in the
first place, or as a result of taking SSRI's.

The American Association of Clinical Endocrinologists alerts us to
the prevalence of Hypogonadism misdiagnosis in its adult male Hypogonadism
guidelines. The patient is normally placed on anti-depressants instead.

SSRI drugs have been found to cause low Free Testosterone as well as
sexual dysfunction. Low Free Testosterone is indicative of Hypogonadism.

Hypogonadism has symptoms of lethargy, mood swings,depression and
"brain fog", amongst many others, including for some, sexual dysfunction.
In severe, or long term untreated cases of Hypogonadism, suicidal
tendencies can occur.

Hypogonadism, contrary to popular thought perhaps, does significantly
exist in teens and increases in prevalence as time goes on.

All that being the case, why are we surprised that SSRI's, and other
drugs causing Hypogonadism, of which there are many, lead to depression,
loss of hope and ultimately, suicidal thoughts, especially in the young.
An already confused situation is exacerbated with the introduction of
SSRI's as they slowly demolish endocrine health.

Whilst the limitations of some studies referenced are obvious in
terms of numbers and perhaps testing methods, there must be a serious
question raised as to why these patients are not being properly evaluated
for Hypogonadism, before putting them onto anti-depressants.


1. American Association of Clinical Endocrinologists Medical
guidelines for clinical practice for the evaluation and treatment of
hypogonadism in adult male patients—2002 update Petak SM, Nankin HR, Spark
RF, Swerdloff RS, Rodriguez-Rigau LJ AACE Hypogonadism Guidelines, Endocr
Pract. 2002;8(No. 6)

2.Crenshaw TL, Goldberg JP: Sexual Pharmacology: Drugs That Affect
Sexual Functioning. New York, NY: WW Norton & Company, 1996.

3. Antidepressant-Induced Sexual Dysfunction Associated with Low
Serum Free Testosterone
Presented by Alan J. Cohen, M.D.,
Private Practice and Assistant Clinic Professor of Psychiatry, UCSF
Psychiatry On-Line 1999
revised 10/3/2000

4. Seidman S and Rabkin J (1998) Testosterone replacement therapy for
hypogonadal men with SSRI-refractory depression. J Affect. Disord Mar;

5. Bioavailable Testosterone and Depressed Mood in Older Men: The
Rancho Bernardo Study
Elizabeth Barrett-Connor, Denise G. von Mühlen and Donna Kritz-Silverstein

Competing interests:
No competing Interest, however, author of the Testosterone Deficiency Centre at

Competing interests: No competing interests

02 March 2005
Nicholas J O'Hara Smith
Lay Advocate
Sunbury, Middlesex TW16 7TW