“We found weak evidence of an increased risk of non-fatal self harm, but our results are compatible with either no reduction or a risk that is 2.5 times higher than in placebo-treated patients,” the authors wrote. The possible differences in risk in relation to self harm and suicidal thoughts is noteworthy, they stated. Though the differences could be attributable to chance given the relatively low number of events, they could also be a function of efficacy in treating depression. “The possible rise in self harm may result from a different mechanism, such as a disinhibiting effect of SSRIs in the early stages of treatment.”
The authors' conclusions echo those of most professionals in response to growing concern about the possible connection between suicide risk and SSRI treatment. “In view of the widespread prescribing of SSRIs and the possibility that they may increase the risk of suicidal behavior in some individuals, research is urgently needed both to clarify appropriate indications for their use and to determine whether it is possible to identify people at risk of possible suicidal side effects,” they wrote.
“There's no question that we need more studies on this issue. In particular, we need more long-term follow-up studies. Much of the data currently available are from relatively short-term clinical trials, yet for many people, depression is a chronic illness with multiple relapses. We need to know the risk and benefits of treatment over time,” Dr. Fassler said. “From the child literature, we know that over 40% of young people diagnosed with depression will eventually attempt suicide, and over 3% will ultimately die as a result. But research has also demonstrated that we can reduce suicidal ideation and the risk of relapse with effective and appropriate treatment.”
Several studies funded by the National Institute of Mental Health are underway that will provide insight into the many variables that contribute to suicidal thinking and behavior, “and we have made considerable progress in terms of access to data from clinical trials,” said Dr. Fassler, referring to the growing momentum in support of a centralized public registry.
The new studies “add to the larger and ongoing discussion” about the FDA's ability to evaluate drug dangerousness, Dr. Fassler said. “It's clear that this is a complex issue with no easy answers. The more information we have, the better.”