The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?

The decision made in the year 2004 by the U.S. Food and Drug Administration (FDA) to require a boxed warning on antidepressants regarding the risk of suicidality in young adults still represents a matter of controversy. The FDA warning was grounded on industry-sponsored trials carried one decade ago or earlier. However, within the past decade, […]

Antidepressants and suicidality: History, the black-box warning, consequences, and current evidence

The first published literature on the topic of antidepressants and suicidality dates back to the mid-1950s. Today, 10 years after the black-box warning was issued, this controversial topic is still debated. This article will review the data behind the black-box warning and its revision; address the subsequent impact the warning had on depression diagnoses, prescribing […]

Sociodemographic and gender determinants of late-life suicide in users and non-users of antidepressants

Background The treatment of depression is a main strategy for suicide prevention in older adults. Our aim was to examine factors related to suicide in older adults (75+) with and without antidepressant (AD) therapy. Methods A national population-based register study, including all Swedish residents aged ≥75 years between 2006 and 2014 (N = 1 413 806). A nested case–control design […]

Effects of bupropion (wellbutrin) on suicidal behavior, risk taking behavior, and mood

This study analyzed the effects that the well known antidepressant Wellbutrin (Bupropion) has on risk taking behavior, suicidal behavior, social behavior, and motivation. Despite Bupropion’s ability to improve motivation it has been associated with numerous suicides. There have been reports that state that Bupropion is the worst antidepressant for treating suicidal behaviors and may even […]

Antidepressant dose, age, and the risk of deliberate self-harm

OBJECTIVE: To assess the risk of deliberate self-harm by antidepressant dose, by age group. DESIGN, SETTING, AND PARTICIPANTS: This was a propensity score-matched cohort study using population-based health care utilization data from 162,625 US residents with depression ages 10 to 64 years who initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal or at […]

Problematic advice from suicide prevention experts

Based on a 10-year systematic review of suicide prevention strategies, “29 suicide prevention experts from 17 European countries” recommend 4 allegedly evidence-based strategies to be included in national suicide prevention programs. One of the recommended strategies is pharmacological treatment of depression. This recommendation is problematic for several reasons. First, it is based on a biased […]

Newer-generation antidepressants and suicide risk in randomized controlled trials: A re-analysis of the FDA database

The aim of this paper was to examine whether the use of newer-generation antidepressants, relative to placebo, bear an increased risk of (attempted) suicide when the analysis is based on the number of patients instead of patient exposure years (PEY.)

Concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem and risk for suicide: A case-control and case-crossover study.

Purpose To evaluate whether the concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem increases the risk of suicide or triggers suicide compared with the use of zolpidem alone. Methods We conducted a case–control and case–crossover study using the Korean National Health Insurance ServiceNational Sample Cohort database. Cases were older than 20 years with a […]

Antidepressant use among persons aged 12 and over: United States, 2011-2014.

Antidepressants are one of the three most commonly used therapeutic drug classes in the United States (1). While the majority of antidepressants are taken to treat depression, antidepressants can also be taken to treat other conditions, like anxiety disorders. This Data Brief provides the most recent estimates of antidepressant use in the U.S. noninstitutionalized population, […]

Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: Cohort study using a primary care database.

Objective To assess the associations between different antidepressant treatments and the rates of suicide and attempted suicide or self harm in people with depression. Design Cohort study. Setting Patients registered with UK general practices contributing data to the QResearch database. Participants 238 963 patients aged 20 to 64 years with a first diagnosis of depression between 1 January 2000 and […]

Precursors to suicidality and violence on antidepressants: Systematic review of trials in adult healthy volunteers.

OBJECTIVE: To quantify the risk of suicidality and violence when selective serotonin and serotonin-norepinephrine reuptake inhibitors are given to adult healthy volunteers with no signs of a mental disorder. DESIGN: Systematic review and meta-analysis. MAIN OUTCOME MEASURE: Harms related to suicidality, hostility, activation events, psychotic events and mood disturbances. SETTING: Published trials identified by searching […]

Antidepressants and suicide: Risk-benefit conundrums.

There has been a long-standing controversy about the possibility that selective serotonin reuptake inhibitor (SSRI) antidepressants might induce suicidality in some patients. To shed light on this issue, this paper reviews available randomized controlled trials (RCTs), meta-analyses of clinical trials and epidemiological studies that have been undertaken to investigate the issue further. The original clinical […]

Antidepressants and suicide among young women in Sweden 1999-2013.

OBJECTIVE: To establish whether the young women (15–24 year old) who committed suicide in Sweden (1999–2013) received antidepressant treatment or not, and to what extent, prior to and/or at the time of suicide. To investigate the belief that increased prescription of antidepressants would drastically reduce the number of suicides. METHODS: An analysis of data from […]

STAR*D: A tale and trail of bias.

The 35-million-dollar Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study is the largest antidepressant effectiveness study ever conducted. STAR*D enrolled 4,041 depressed patients and provided them with exemplary free acute and continuing antidepressant care to maximize their likelihood of achieving and maintaining remission. Patients who failed to get adequate relief from their first antidepressant were provided with […]

Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis.

Major depressive disorder is one of the most common, burdensome, and costly psychiatric disorders worldwide in adults. Pharmacological and non-pharmacological treatments are available; however, because of inadequate resources, antidepressants are used more frequently than psychological interventions. Prescription of these agents should be informed by the best available evidence. Therefore, we aimed to update and expand our previous work to […]

Methodological flaws, conflicts of interest, and scientific fallacies: Implications for the evaluation of antidepressants`efficacy and harm

Background: In current psychiatric practice, antidepressants are widely and with ever-increasing frequency prescribed to patients. However, several scientific biases obfuscate estimates of antidepressants’ efficacy and harm, and these are barely recognized in treatment guidelines. The aim of this mini-review is to critically evaluate the efficacy and harm of antidepressants for acute and maintenance treatment with respect […]

Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: Choice of antidepressant and dose.

The Dutch guideline for the treatment of depression in young people recommends initiating antidepressant treatment with fluoxetine, as the evidence for its efficacy is strongest and the risk of suicidality may be lower than with other antidepressants. Furthermore, low starting doses are recommended. We aimed to determine whether antidepressant prescriptions are in accord with guidelines. […]

The use of the Psychiatric Electroencephalography Evaluation Registry (PEER) to personalize pharmacotherapy.

This study aims to determine whether Psychiatric Electroencephalography Evaluation Registry (PEER) Interactive (an objective, adjunctive tool based on a comparison of a quantitative electroencephalogram to an existing registry of patient outcomes) is more effective than the current standard of care in treatment of subjects suffering from depression. In this post hoc interim analysis subjects were […]

Suicide and suicide attempts in adolescents.

Suicide is the second leading cause of death for adolescents 15 to 19 years abstract old. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist pediatricians, in collaboration with other child and adolescent health care professionals, in the identifi cation and management of the adolescent at risk […]

Suicidal thoughts and behavior with antidepressant treatment: Reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine.

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Post-mortem studies of brain phosphatidylinositol hydrolysis in depression and the effect of antidepressant treatment.

Basal, neurotransmitter and G protein-mediated 3HPI hydrolysis was measured in the frontal cortex, temporal cortex, hippocampus and thalamus from suicides, with a firm retrospective diagnosis of depression, and individually matched controls. Suicides were divided into those who had been free of antidepressant drugs for at least 3 months and those in whom prescription of antidepressants […]

Suicidality and aggression during antidepressant treatment: Systematic review and meta-analyses based on clinical study reports.

Objective To study serious harms associated with selective serotonin and serotonin-norepinephrine reuptake inhibitors. Design Systematic review and meta-analysis. Main outcome measures Mortality and suicidality. Secondary outcomes were aggressive behaviour and akathisia.We included 70 trials (64 381 pages of clinical study reports) with 18 526 patients. These trials had limitations in the study design and discrepancies […]

Physician perception regarding side-effect profile at the onset of antidepressant treatment: A survey of Israeli psychiatrists and primary care physicians.

One of the major factors affecting treatment compliance and outcome in patients is the wide range of side effects (SEs) associated with antidepressants. In the present study, we aimed to assess the extent to which Israeli primary care (PC) physicians and psychiatrists discuss the SEs of selective serotonin reuptake inhibitors (SSRIs) with patients prior to […]