SSRIs and suicide

SSRIs and suicide

SSRIs are less toxic and have fewer unwanted effects than tricyclic antidepressants but it seems they may, paradoxically, induce suicidal behaviour in the young.
It is not easy to establish whether this is true because depression also increases suicide risk and the data are contradictory. Pharmaco-epidemiological and ecological studies suggest that increased use of SSRIs may have resulted in a reduction in youth suicide, and that SSRIs are not taken more often than expected by young suicide victims. However, a review of 24 controlled trials with more than 4400 children and teenagers by the US Food and Drug Administration showed a small (2%) short-term increase in the incidence of suicidality (suicidal thoughts or attempts) in those receiving antidepressants (mostly SSRIs) compared with placebo. There were no completed suicides and this result was not replicated when questionnaires, rather than reports from parents or children, were used as the basis for information. According to this research, 50 teenagers need to be treated for one to develop suicidality attributable to the antidepressant.

The mechanisms underlying this phenomenon are unclear but SSRIs, particularly paroxetine, can induce akathisia, agitation and irritability — so-called ‘activation' — and this may be an indicator of increased suicide risk.