Antidepressants and Suicidal Behavior: are we Hurting or Helping?

In this commentary, the authors address the ongoing discussion of potential increases in suicide risk among patients being treated with antidepressant drugs. A comprehensive meta-analysis failed to show either increased or decreased risk with antidepressants of all types, nor significant differences between serotonin reuptake-inhibitors & tricylics. The authors propose prudent clinical practice calls for particularly close monitoring of patients starting on any mood-elevating treatment in certain high risk circumstances, including any patients with previous suicidal behaviour & adults or children, especially new patients, who present with or develop agitated-irritable features or who may have undiagnosed bipolar or psychotic disorders. (27 refs.)