Connection between SSRIs, suicide coming under review

Studies will undertake a variety of approaches ranging from examining large databases to developing assessment tools.

By Susan J. Landers, AMNews staff. Dec. 18, 2006.

Washington -- Five newly funded studies will soon delve into one of medicine's knottier questions: Do antidepressants, particularly the new and popular SSRIs, cause suicidal thoughts and behaviors?

The National Institute of Mental Health is betting that these studies can at least begin to unravel that mystery as the findings emerge in the coming years. The announcement provoked both praise and questions from close observers.

Balancing the risks and benefits of selective serotonin reuptake inhibitors, particularly for children and teens with depression, has emerged as a difficult call for physicians. On the one hand, studies show that the medications are helpful in treating moderate and severe depression among this group. But on the other, concerns about the drugs prompted the Food and Drug Administration to require that their labels carry black-box warnings for suicide risk.

Although there were no suicides among the nearly 2,200 children in studies reviewed by the FDA, the rate of suicidal thinking or behavior, including actual suicide attempts, was 4% for those on the medications compared with 2% for those on placebo.

"These new, multiyear projects will clarify the connection between SSRI use and suicidality," said NIMH Director Thomas Insel, MD, in a statement. "They will help determine why and how SSRIs may trigger suicidal thinking and behavior in some people but not others, and may lead to new tools that will help us screen for those who are most vulnerable."