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Effects of selective serotonin reuptake inhibitors on rating-scale-assessed suicidality in adults with depression

Journal article
Authors Jakob Näslund
Fredrik Hieronymus
Alexander Lisinski
Staffan Nilsson
Elias Eriksson
Published in British Journal of Psychiatry
Volume 212
Issue 3
Pages 148-154
ISSN 0007-1250
Publication year 2018
Published at Department of Mathematical Sciences
Institute of Neuroscience and Physiology, Department of Pharmacology
Pages 148-154
Language en
Keywords randomized controlled-trials, antidepressant treatment, fluoxetine, treatment, placebo, risk, ideation, metaanalysis, rates, association, emergence, Psychiatry
Subject categories Psychiatry


Background Selective serotonin reuptake inhibitors (SSRIs) have been claimed to elicit or aggravate suicidal ideation. To explore the effect of SSRIs on the suicidality item of the Hamilton Rating Scale for Depression (HRSD). We undertook a patient-level mega-analysis of adults with depression participating in industry-sponsored studies of sertraline, paroxetine or citalopram, comparing patients on an SSRI (n = 5681) with those on placebo (n = 2581) with respect to HRSD-rated suicidality. Separate analyses were conducted for young adults (age 18-24; n = 537) and adults (age = 25; n = 7725). Among adults, the reduction in mean rating of suicidality was larger and the risk for aggravation of suicidality lower in patients receiving an SSRI from week 1 and onwards. In young adults, SSRI treatment neither reduced nor increased suicidality ratings relative to placebo at the end-point. The net effect of SSRIs on suicidality appears beneficial in people above the age of 24 and neutral in those aged 18-24.

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