Do selective serotonin reuptake inhibitors cause suicide?

Editor—Depressed people are at increased risk of suicide, and our aim was to draw attention to the clinical severity of the problem, focusing on the real clinical dilemmas. Accurate estimation of the risk of suicide in depressed people is a crucial clinical issue. Research has been trying to measure this phenomenon for more than 30 years, and contrasting figures have been reported.^1-3 The true suicide risk for the average patient remains uncertain.⁴ In our editorial we used the sentence “up to 15% of patients with unipolar depression eventually commit suicide” to emphasise the need to take this outcome very seriously, and we cited a paper by Davies et al to acknowledge how uncertain the exact risk remains.⁵

Additionally, we wanted to highlight an apparent existing paradox in the role of antidepressants in the treatment of depression. Instead of debating which antidepressants are more effective in reducing the risk of suicide by treating the depressive symptoms effectively, much current literature focuses on which antidepressants are less dangerous in causing suicide as an unwanted effect of treatment. This paradox indicates that further research is urgently needed to shed light on these issues.

In the meantime, doctors need to keep up to date with emerging research findings,^w1-w3 bearing in mind that untreated or inadequately treated individuals with moderate to severe depression are at increased risk of suicide.