Do SSRIs Really Induce Suicidal Behavior? : The Critical Review of Evidences

Kim, Won; Bahk, Won Myong

Abstract

In recent years there has been increased media scrutiny and criticism about the use of selective serotonin reuptake inhibitors (SSRIs) and their possible association with suicidal behavior. In clinical practice, these may confuse many patients with depressive disorder and some doctors. Since early 1990s some authors reported that antidepressants could be related with increased suicidality. However, considering the limitation of study design, there is no evidence that suicide is precipitated by SSRIs or older antidepressants. There were merely some reports of weak correlation between non-fatal self harm and SSRIs, with the number needed to treat for self-harm being approximately 1 in 700-1,000. It is also informative that the correlation between self-harm and tricyclic antidepressants(TCAs) is not different with SSRIs and that psychotherapy unto adolescents with depressive disorder has been reported to have similar correlation with suicidal thoughts as that with antidepressants. These suggest that the suicidal risks is not specifically due to the use of SSRIs, but broadly related with all other treatment for depression. We should consider the benefits and risks when choosing a specific treatment. The efficacy of SSRIs has been verified for the treatment of depressive symptoms and for relieving suicidal thoughts in most patients. Compared to the minuscule possibility of suicidal risks (NNT : 700~1,000), the efficacy of SSRIs improving depression is much more powerful and important (NNT : 4~7). Some assumed that SSRIs alleviate depressive symptoms and suicidal thoughts in most population and there may be small population vulnerable to self-harm with SSRIs. Considering the researches of Scandinavia reporting that many adolescents commit suicide with no history of antidepressants medication, there are also suicidal risks associated with non-treatment, and they have not had the potential benefit of antidepressants. It is a matter of course that clinicians should have a close monitoring of suicidal risk when treating depressed patients and prescribing SSRIs, especially early 2 weeks in the treatment. There is a risk that media reports will result in discouraging compliance with effective treatment for depression and potential relief from suicide.