Citation

Healy D, Aldred G. Int. Rev. Psychiatry 2005; 17(3): 163-172.

Affiliation

North Wales Department of Psychological Medicine, Cardiff University, Hergest Unit, Bangor, Wales LL57 2PW, UK. healy_hergest@compuserve.com

Copyright

(Copyright © 2005, Informa - Taylor and Francis Group)

DOI

10.1080/09540260500071624

PMID

16194787

Abstract

There have been longstanding concerns about the propensity of antidepressants to precipitate suicidality in vulnerable individuals. To investigate this further, first we have analyzed all clinical trials, and in particular trials submitted to regulators for evidence on the relative risk of antidepressants versus placebo for this hazard. Second, we have compiled current epidemiological evidence germane to the issue. Third, we have constructed a model (Investigative Medication Routine; IMR) to shed light on the interactions between drug uptake, patient numbers on treatment and suicidal events. The clinical trial data gives rise to a relative risk of suicide on antidepressants over placebo of the order of a 2.0-2.5 times greater risk with treatment. These figures are supported by epidemiological findings. Investigative Medication Routine translates such findings into estimates of likely adverse outcomes, and explains why apparently increasing consumption of antidepressants would not be expected to lead to increased national suicide rates. From this data, we conclude that there is a clear signal that suicides and suicidal acts may be linked to antidepressant usage. It would seem likely that explicit warnings and monitoring in the early stages of treatment could greatly minimize these hazards.