Suicides and Suicide Attempts during Long-Term Treatment with Antidepressants: A Meta-Analysis of 29 Placebo-Controlled Studies Including 6,934 Patients with Major Depressive Disorder

@article{Braun2016SuicidesAS,
  title={Suicides and Suicide Attempts during Long-Term Treatment with Antidepressants: A Meta-Analysis of 29 Placebo-Controlled Studies Including 6,934 Patients with Major Depressive Disorder},
  author={Cora Braun and Tom Bschor and Jeremy Franklin and Christopher Baethge},
  journal={Psychotherapy and Psychosomatics},
  year={2016},
  volume={85},
  pages={171 - 179}
}
Background: It is unclear whether antidepressants can prevent suicides or suicide attempts, particularly during long-term use. Methods: We carried out a comprehensive review of long-term studies of antidepressants (relapse prevention). Sources were obtained from 5 review articles and by searches of MEDLINE, PubMed Central and a hand search of bibliographies. We meta-analyzed placebo-controlled antidepressant RCTs of at least 3 months' duration and calculated suicide and suicide attempt… 

Figures and Tables from this paper

Suicide risk with selective serotonin reuptake inhibitors and new-generation serotonergic-noradrenergic antidepressants in adults: a systematic review and meta-analysis of observational studies
TLDR
Exposure to new-generation antidepressants is associated with increased suicide risk in adult routine-care patients with depression and other conditions and contributes to systematic underestimation of risk estimates in the published literature.
[The problem of suicide in depression in the modern world].
  • N. Petrova
  • Psychology, Medicine
    Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova
  • 2022
TLDR
There is no generally accepted model of prevention, but it is recommended that patients be observed during the first 4 weeks of treatment for depression, as well as during the period of antidepressant dose modification.
Treatment-resistant depression and suicidality.
Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies
TLDR
Exposure to new-generation antidepressants is associated with higher suicide risk in adult routine-care patients with depression and other treatment indications and likely contribute to systematic underestimation of risk in the published literature.
Suicidal Ideation and Suicidal Behavior as Rare Adverse Events of Antidepressant Medication: Current Report from the AMSP Multicenter Drug Safety Surveillance Project
TLDR
The study supports the view that antidepressant drug-triggered suicidal ideation and suicidal behavior (primarily with selective serotonin reuptake inhibitors) are rare and might be preferable to antidepressant drug monotherapy when beginning treatment.
Observing time effect of SSRIs on suicide risk and suicide-related behaviour: a network meta-analysis protocol
TLDR
This protocol of network meta-analysis aims to precisely evaluate the time effects of SSRIs by observing weekly changes of suicidality in the first 2 months of the treatment, and consequently, to explore whether the effect of theSSRIs on suicide varies depending on the stages of thetreatment; if so, it will identify the turning point.
...
...

References

SHOWING 1-10 OF 76 REFERENCES
Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: an analysis of the Food and Drug Administration database.
TLDR
Assessment of suicides, suicide attempts, and depressive symptom reduction in studies of 7 new antidepressants using the Food and Drug Administration database may help inform discussions about the use of placebo in antidepressant clinical trials.
Suicide in 406 Mood-Disorder Patients With and Without Long-Term Medication: A 40 to 44 Years' Follow-Up
ABSTRACT There is no data on the variation in the suicide risk over lifetime and on the suicide-preventive effect of the long-term treatment of mood-disorder patients with antidepressants and
Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA's safety review
TLDR
No evidence that SSRIs increased the risk of suicide is found, but important protective or hazardous effects cannot be excluded, and larger trials with longer follow up are required to assess the balance of risks and benefits fully.
Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: a replication analysis of the Food and Drug Administration Database.
TLDR
Suicide risk and symptom reduction among placebo-treated patients participating in antidepressant clinical trials for two recently approved antidepressants, venlafaxine ER and citalopram, which were unavailable during the previous study are assessed.
Suicide Rates in Short-term Randomized Controlled Trials of Newer Antidepressants
TLDR
Neither use of placebo nor of antidepressants in short-term RCTs was associated with an increased risk of completed suicide among patients with MDD or various anxiety disorders.
Suicide risk in placebo-controlled studies of major depression.
TLDR
Fear of increased risk of attempted suicide in the placebo groups should not be an argument against performing short-term and long-term, placebo-controlled trials in major depression.
Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports.
TLDR
Findings fail to support either an overall difference in suicide risk between antidepressant- and placebo-treated depressed subjects in controlled trials or a difference between SSRIs and either other types of antidepressants or placebo.
Meta-analysis of efficacy and treatment-emergent suicidality in adults by psychiatric indication and age subgroup following initiation of paroxetine therapy: a complete set of randomized placebo-controlled trials.
TLDR
Overall suicidality incidence was similar between paroxetine and placebo, but in patients with major depressive disorder (MDD), a higher frequency of suicidal behavior occurred with paroxete in MDD, which was largely explained by the higher incidence in young adults.
Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration
TLDR
The net effect seems to be neutral on suicidal behaviour but possibly protective for suicidal ideation in adults aged 25-64 and to reduce the risk of both suicidality and suicidal behaviour in those aged ≥65.
Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials.
TLDR
The authors' systematic review, which included a total of 87 650 patients, documented an association between suicide attempts and the use of SSRIs.
...
...