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Hengartner et al. conducted a meta-analysis on suicide risk with selective serotonin reuptake inhibitors (SSRI) and other new-generation antidepressants in adults (1). Although the pooled relative risks (RRs) of SSRI for suicide risk including suicide and suicide attempt in patients with depression and in patients with all indications did not reach the level of significance, the pooled RR (95% confidence intervals [CIs]) of any new-generation antidepressant for suicide risk in patients with depression and in patients with all indications were 1.29 (1.06-1.57) and 1.45 (1.23-1.70), respectively. The authors presented information on the different suicide risk between SSRI and other new-generation antidepressants , and I present additional information regarding the relationship.
First, Sharma et al. conducted a meta-analysis on the association of SSRI and serotonin-norepinephrine reuptake inhibitors with suicidality and other mental indicators (2). Although the pooled odds ratios (ORs) of antidepressant treatment for suicidality and aggression did not reach the level of significance in adults, the pooed ORs (95% CIs) of antidepressant treatment for suicidality and aggression were 2.39 (1.31-4.33) and 2.79 (1.62-4.81) in children/adolescents. The suicide risk differed in different generations, and suicide risk estimation should be conducted by stratification with generation and type of anti-depressants.
Second, Hengartner and Plöderl reported that odds ratios (OR...
Second, Hengartner and Plöderl reported that odds ratios (ORs) (95% confidence intervals [CIs]) of antidepressant treatment for suicides and suicide attempts were 2.83 (1.13-9.67) and 2.38 (1.63-3.61), respectively (3). By using the same database, Kaminski et al. reported that ORs (95% CIs) of antidepressant treatment for suicides and suicide attempts were 1.98 (0.71-5.50) and 1.63 (1.09-2.43), respectively (4). In case of rare events, the level of significance in OR differed by applying different analytical approaches. This means that marginal level of significance should be verified by further studies, and a meta-analysis with high quality of papers is recommended to confirm the association.
1. Hengartner MP, Amendola S, Kaminski JA, et al. Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies. J Epidemiol Community Health 2021 Mar 8. doi: 10.1136/jech-2020-214611. [Epub ahead of print]
2. Sharma T, Guski LS, Freund N, et al. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.
3. Hengartner MP, Plöderl M. Newer-generation antidepressants and suicide risk in randomized controlled trials: A re-analysis of the FDA database. Psychother Psychosom 2019;88(4):247-248.
4. Kaminski JA, Bschor T. Antidepressants and suicidality: A re-analysis of the re-analysis. J Affect Disord 2020;266:95-99.