I want to present a single paper on the topic for the moment. It’s a meta-review: it reviews the existing reviews/summaries of what is known, and it’s perfect for someone like me who really needs the high-level view of the topic. There are some newer reviews on the topic, but none so thorough as this. I’m only focusing on a single comparison, but the paper goes into several other topics.
Here’s the paper, full text, not behind a paywall:
This figure really tells the story. It breaks down whether the literature supports an increased risk for suicide attempts in people taking placebo or SSRI antidepressants. The effect is rather weak, but multiple studies support this slight increase.
What I look for in data like this are error bars that don’t overlap the midline… in other words we can be reasonably confident that there’s a reproducible “real” difference between these two groups, and that difference supports an increased risk in people taking the drug.
I always need to caution people who read these types of epidemiological data with the standard warning:
“WARNING: The risk assessments here are STATISTICAL ONLY. Being 5% more likely to make a suicide attempt does not mean SSRI’s will cause you to attempt suicide! It may have an effect on a susceptible proportion of the population, but all we can say for sure is that SSRI users are slightly higher risk than placebo users with depressive conditions”
Scientists have to be very careful communicating these risks, because we’re so used to minor statistical differences between very large groups that we forget that patients don’t see themselves as statistics or group members… they translate stochastic risk into deterministic outcomes.
I’m not sure if I follow why the sex differences are significant. I gather from the literature that depression in women can be related to PMDD, possibly using a mechanism different than non sex hormone specific depression pathways in the brain?
It’s also interesting to me that pharma-funded research is actually more likely to find increase suicide attempt risk than non-pharma funded.
The paper contains a nice summary of findings, which I will briefly quote here:
“We documented a more than twofold increase in the rate of suicide attempts in patients receiving SSRIs compared with placebo or therapeutic interventions other than tricyclic antidepressants. Although many trials have documented the benefits of SSRIs in many forms of depression and other clinical indications, it has been difficult to document the relatively rare but very serious risk of suicide. We documented a difference in absolute risk of 5.6 suicide attempts per 1000 patient years of SSRI exposure compared with placebo. Although small, the incremental risk remains a very important population health issue because of the widespread use of SSRIs. In the United Kingdom, 1 million person years of SSRI treatment are provided annually by general practitioners.13 For the United States, the number of visits by patients for depression was 24.5 million in 2001, a 70% increase since 1987.1 In 2001, 69% of patient visits for depression resulted in prescriptions for SSRIs.1 Thus, a large number of patients were at risk for treatment induced suicidality.”