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

Abstract

Background: Selective serotonin reuptake inhibitors (SSRIs) have been claimed to elicit or aggravate suicidal ideation. Aims: To explore the effect of SSRIs on the suicidality item of the Hamilton Rating Scale for Depression (HRSD). Method: 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 HRSDrated suicidality. Separate analyses were conducted for young adults (age 18-24; n = 537) and adults (age ?25; n = 7725). Results: 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. Conclusions: The net effect of SSRIs on suicidality appears beneficial in people above the age of 24 and neutral in those aged 18-24.