Citation

Lader M. Clin. Risk 2007; 13(3): 85-88.

Copyright

(Copyright © 2007, Royal Society of Medicine Press)

DOI

10.1258/135626207780559923

PMID

unavailable

Abstract

The acceptability of antidepressants among both professionals and the lay public. including depressed patients. has been set back by insistent reports of an enhanced suicidal risk. This encompasses suicidal ideas. intention. attempts and completed acts. Such behaviour is an intrinsic feature of the more depressed individuals and it is difficult to disentangle the risks (or protection) afforded by the use of antidepressants from the background risk. Clinical trials contain too little data even on meta analysis to allow firm conclusions. especially with respect to suicide itself. At the other end of the continuum. correlation of prescribing data and suicide data suggests a protective effect of antidepressants. especially the selective serotonin reuptake inhibitors (SSRIs). Other GP databases suggest that a major effect on completed suicide can be ruled out. but that suicidal attempts may be somewhat more frequent in patients taking antidepressants. Against this. other causes of mortality in depressed patients are markedly lower in SSRI-taking patients. An exception is venlafaxine which may be associated with a discernibly enhanced risk. but differential allocation to groups cannot be excluded. The efficacy of antidepressants in children and adolescents is weaker than in adults. and only significant for fluoxetine. The risks of suicidal behaviour may be increased in this age group; careful choice of medication and close monitoring are essential. In adults. the suicidal risk should be carefully assessed and patients managed accordingly. They and their carers should be warned of a possible delay in onset of effect. 'Ex-label' use is especially problematic. All in all. the antidepressants have a favourable risk/benefit ratio. but special cases such as children necessitate thoughtful prescribing.

Language: en