SSRI antidepressant given for depression increase suicide attempts, no preventative effect at any age

In a recent study, researchers discovered that SSRIs tripled the risk of suicide attempts in those under the age of 18 and up to doubled the risk in those between the ages of 18 and 24. Even for those who were at a high risk of suicide, they had no preventative effect at any age.

Study led by Tyra Lagerberg at the Karolinska Institute and published in Neuropsychopharmacology states,

“The present study finds similar results to prior observational research—that is, consistent evidence of an increased risk of suicidality during treatment with SSRIs in children and adolescents,”

A Swedish registry provided the information, which included 162,267 individuals who had been given a depression diagnosis. Of these, 109,350 people did not start taking an SSRI antidepressant within 28 days, while 52,917 did. The result of interest was suicide attempts as they were listed in the registry. The data were examined after three months and after a year by the researchers.

The researchers used two different approaches to handling the outcome data: the intention-to-treat analysis and the per-protocol analysis. The ideal situation is to combine the two so that the reader can see all the information.

Both the intention-to-treat analysis and the per-protocol analysis in this case demonstrated that SSRI use was linked to an increase in suicide attempts in people under the age of 25. The effect’s magnitude was the only thing that varied. 6-17-year-olds were 2.9 times more likely to attempt suicide while taking SSRIs in the intention-to-treat analysis.

In the per-protocol analysis, their likelihood increased by 3.34 times. In the intention-to-treat analysis and the per-protocol analysis, those between the ages of 18 and 24 had 1.59 and 2.01 times, respectively, higher rates of suicide attempts. However, neither analysis found that antidepressant use increased the risk of suicide attempt in people over 25.

Antidepressants did not, however, have a preventative effect, as evidenced by the null finding, which also indicates that they did not lower the likelihood of suicide in people over 25. This study’s primary flaw is that the researchers were unable to take baseline severity into account.

In other words, it is possible that people with more severe depression—and thus a higher risk of suicide—were more likely to take an antidepressant. This is particularly true given that the researchers note that Sweden’s first-line therapy for mild-to-moderate depression is psychotherapy. The researchers were able to account for people who had previously engaged in suicidal behavior, which is a good proxy for people who are most at risk of attempting suicide in the future.

No matter whether they were taking antidepressants or not, those who had previously failed were more likely to do so again. Antidepressants didn’t appear to make the issue worse or to be of any assistance, in other words.

As per researcher, “Those with a history of suicidal behavior (N = 4221) showed greater absolute risks among both initiators and non-initiators. We found no evidence of a difference between initiators and non-initiators in this group in terms of suicidal behavior risk.”

Probably the best way to interpret the study’s findings is, taking an antidepressant increases your risk of trying to commit suicide by up to three times if you are under the age of 25, have no prior history of suicidal behavior, and your risk of trying to commit suicide declines with age.

Taking an antidepressant does not prevent suicide in people 25 and older. Similar to this, taking an antidepressant doesn’t lower the risk for those who are at a high risk of suicide. The result is in line with earlier research, which has repeatedly demonstrated that antidepressants raise the risk of suicide, particularly in children and adolescents, with some studies showing an increase of more than a doubling and at least one analysis showing an increase of a sixfold.

Antidepressant medications have been shown to worsen long-term outcomes, even after adjusting for the severity of depression at baseline.

And one of the study findings is, people who have more severe depression, concurrent anxiety disorders, and suicidal thoughts are least likely to benefit from antidepressant medication.