Citation

Brådvik L, Berglund M. Psychiatry Research Journal 2011; 2(1-2): 15-36.

Copyright

(Copyright © 2011)

DOI

unavailable

PMID

unavailable

Abstract

Retrospective diagnosis of suicide victims has revealed that at least half of them have suffered from a depressive disorder. Treatment of depression with antidepressants would therefore be expected to prevent suicide but the role of antidepressant pharmacotherapy in the prevention of suicide has been difficult to evaluate. Randomised double-blind placebo-controlled studies could be considered the best way of evaluating the effect on suicidal behaviour, but those studies have only been performed as secondary analyses examining the effect of pharmacotherapy on depressive symptoms. They have been performed on low-risk populations, and suicidal patients have been excluded for ethical reasons. Retrospective and pseudo-prospective case-control studies inherit the risk of confounders, as treatment was not randomised. Naturalistic studies of trends cannot investigate other factors related to a decrease in suicide rates. Descriptive studies on treatment before suicide may show low rates of treatment, but still do not prove that treatment would have been effective if given. Furthermore, complications of the prescription of antidepressants include non-compliance and risk of overdoses in suicidal people. Apart from evaluating the possible effect of antidepressants in the prevention of suicide, certain questions need to be answered concerning the relationship between depression and suicide. Not all depressives suffer from an uncomplicated major depressive disorder. Sometimes depression is secondary to substance abuse and sometimes depression has melancholic or psychotic features. Furthermore, some investigators have postulated existence of a suicidal syndrome independent of depression, which may have implications for the efficacy of antidepressant pharmacotherapy on suicidal behaviour. Finally, a third way to investigate possible risk or benefit of antidepressants on non-fatal and fatal suicidal behaviour may be to identify certain risk groups for suicidal behaviour despite antidepressant pharmacotherapy. © 2011 Nova Science Publishers, Inc.

Language: en

Keywords

human; alcoholism; depression; psychosis; major depression; suicidal behavior; comorbidity; disease severity; drug overdose; substance abuse; article; prescription; antidepressant agent; disease association; retrospective study; high risk population; melancholia; placebo; patient compliance; drug efficacy; risk benefit analysis; drug withdrawal; drug effect; prospective study; case control study; treatment failure; drug indication; treatment response; descriptive research; randomized controlled trial (topic); low risk population