Abstract
Background
There is ongoing controversy whether antidepressant use alters suicide
risk in adults with depression and other treatment indications.
Methods
Systematic review of observational studies, searching MEDLINE, PsycINFO,
Web of Science, PsycARTICLES and SCOPUS for case–control and cohort studies. We
included studies on depression and various indications unspecified (including
off-label use) reporting risk of suicide and/or suicide attempt for adult
patients using selective serotonin reuptake inhibitors (SSRI) and other
new-generation antidepressants relative to non-users. Effects were
meta-analytically aggregated with random-effects models, reporting relative
risk (RR) estimates with 95% CIs. Publication bias was assessed via funnel-plot
asymmetry and trim-and-fill method. Financial conflict of interest (fCOI) was
defined present when lead authors’ professorship was industry-sponsored, they
received industry-payments, or when the study was industry-sponsored.
Results
We included 27 studies, 19 on depression and 8 on various indications
unspecified (n=1.45 million subjects). SSRI were not definitely related to
suicide risk (suicide and suicide attempt combined) in depression (RR=1.03,
0.70–1.51) and all indications (RR=1.19, 0.88–1.60). Any new-generation
antidepressant was associated with higher suicide risk in depression (RR=1.29,
1.06–1.57) and all indications (RR=1.45, 1.23–1.70). Studies with fCOI reported
significantly lower risk estimates than studies without fCOI. Funnel-plots were
asymmetrical and imputation of missing studies with trim-and-fill method
produced considerably higher risk estimates.
Conclusions
Exposure to new-generation antidepressants is associated with higher
suicide risk in adult routine-care patients with depression and other treatment
indications. Publication bias and fCOI likely contribute to systematic
underestimation of risk in the published literature.
Registration
Open Science Framework, https://osf.io/eaqwn/
Subject
Public Health, Environmental and Occupational Health,Epidemiology
Cited by
26 articles.
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