SSRIs & suicide: most extensive study of its kind determines link between SSRI

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Thu, 17 Feb 2005 21:52:55 -0500

 

 

 

[sSRI-Research] SSRIs & suicide: most extensive study of its

kind determines link between SSRI anti-depressants and risk of suicide

 

 

 

http://www.newswire.ca/en/releases/archive/February2005/17/c5881.html

 

Most extensive study of its kind determines link between SSRI

anti-depressants and risk of suicide

 

Study also highlights some concerns in reporting mechanisms.

 

OTTAWA, Feb. 17 /CNW Telbec/ - Basing their conclusions on an

exhaustive

review of published randomized controlled trials of selective serotonin

reuptake inhibitors (SSRIs), a group of investigators led by Dr. Dean

Fergusson, a scientist at the Ottawa Health Research Institute (OHRI)

and an associate professor at the University of Ottawa, has found that

anti-

depressants contribute to a two-fold increase in the risk of suicide

attempts.

 

RESOLVING A CONTENTIOUS ISSUE

 

Intrigued by a lengthy and well publicized debate questioning a link

between anti-depressants and risk of suicide, Dr. Fergusson quickly

realized that, given his extensive background in epidemiologic and

analytic

research, he could likely contribute to the answer. The study never

questioned the value of these medications, but his findings, published

in the most

recent edition of the BMJ, inspire some concern and strongly encourage

a closer

monitoring of individuals who take these widely prescribed drugs.

The research included a review of studies of all SSRIs - a class

of anti-

depressant drugs which are widely prescribed and have been used to treat

an ever-expanding list of clinical conditions. The research team reviewed

randomized controlled trials comparing an SSRI with either placebo or an

active, non-SSRI control. The study excluded abstracts, crossover

trials, and

all trials whose follow-up was less than one week. As a result, 702 trials

were included in the study (representing 87, 650 patients with a wide

range of

clinical conditions) looking at both fatal and non-fatal suicide

attempts. The

overall rate of suicide attempts was 3.9 (95% confidence interval 3.3

to 4.6)

per 1000 patients treated in clinical trials. When they used study

duration as

exposure time, Dr. Fergusson and his team found an incidence of 18.2

suicide

attempts per 1000 patient. For the trials conducted in patients

diagnosed with

depression, the overall rate of suicide attempts was 4.9 (95% confidence

interval 4.2 to 5.6 per 1000 patients).

 

Overall, the study noted a significant increase (more than twofold) in

the odds of suicide attempts for patients receiving SSRIs compared with

placebo or therapeutic interventions other than tricyclic

antidepressants -

another class of drugs. When compared to tricyclics, no increase in

risk was

found. Although it might appear small, the incremental risk remains a very

important population issue because of the widespread use of SSRIs.

While other

studies have suggested a possible link, this review is now the most

elaborate

and comprehensive research identifying a very real correlation. Dr.

Fergusson's study also observed several major methodological

limitations in

the published trials and he adds that stronger and better reporting

mechanisms

might be in order.

It is still important to note, however, that these medications

have very

important benefits that should not be discounted. Anyone taking these

drugs,

who may have concerns, should first consult a physician or pharmacist.

" This study is important for two reasons, " noted Dr. Fergusson.

" First,

it provides the most comprehensive and conservative evidence to date

on the

association between SSRIs and suicide risk. Second, it highlights

deficiencies

in trial design and the reporting of rare but serious harms. "

" Dr. Fergusson and colleagues' study is timely and highly

significant in

that it raises concern about the relationship between uncommon but very

important adverse events of attempted suicide and commonly prescribed

antidepressant medications, " said Dr. Robert Swenson, Deputy Head of

Psychiatry at The Ottawa Hospital, Associate Professor of Psychiatry

at the

University of Ottawa and a Clinician Investigator at the Ottawa Health

Research Institute. Dr. Swenson was also quick to remind us of the

importance

of these medications. " If antidepressant medication is helpful for their

condition, people should not stop it. If they have concerns about their

medication or their condition is worsening, they should talk to their

doctor

or pharmacist right away. "

" This important study has highlighted the increased risk of suicide

attempts in patients treated with SSRIs across a wide range of clinical

indications, " said Dr. Jeremy Grimshaw, Director of the Clinical

Epidemiology

Program at the OHRI. " It provides important information that will allow

physicians and patients to make more informed decisions about the

benefits and

risks of SSRIs. "

Also involved in the research were: Steve Doucette (research associate

OHRI), Kathleen Cranley Glass (associate professor, McGill

University), Stan

Shapiro (professor, McGill University), David Healey (professor,

University of

Wales College of Medicine), Paul Hebert (senior scientist, OHRI),

Brian Hutton

(research associate, OHRI).

The Ottawa Health Research Institute is the research arm of The Ottawa

Hospital and a major partner of the University of Ottawa Faculties of

Medicine and Health Sciences.

The study was funded in part by the Canadian Institutes of Health

Research.

 

For further information: please contact: Nathalie Trepanier,

Communications Manager OHRI, (613) 798-5555 ext. 19691, Fax: (613)

761-4920, ntrepanier, www.ohri.ca