Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies

Hengartner, Michael Pascal; Amendola, Simone; Kaminski, Jakob A.; Kindler, Simone; Bschor, Tom; Plöderl, Martin

doi:10.1136/jech-2020-214611

Publication type:	Article in scientific journal
Type of review:	Peer review (publication)
Title:	Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies
Authors:	Hengartner, Michael Pascal Amendola, Simone Kaminski, Jakob A. Kindler, Simone Bschor, Tom Plöderl, Martin
et. al:	No
DOI:	10.1136/jech-2020-214611
Published in:	Journal of Epidemiology & Community Health
Issue Date:	2021
Publisher / Ed. Institution:	BMJ Publishing Group
ISSN:	0143-005X 1470-2738
Language:	English
Subjects:	Depression; Epidemiology; Public health; Suicide
Subject (DDC):	615: Pharmacology and therapeutics
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, 1.2–1.70). 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.
URI:	https://digitalcollection.zhaw.ch/handle/11475/22198
Fulltext version:	Published version
License (according to publishing contract):	Licence according to publishing contract
Departement:	Applied Psychology
Organisational Unit:	Psychological Institute (PI)
Appears in collections:	Publikationen Angewandte Psychologie

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Hengartner, M. P., Amendola, S., Kaminski, J. A., Kindler, S., Bschor, T., & Plöderl, M. (2021). Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies. Journal of Epidemiology & Community Health. https://doi.org/10.1136/jech-2020-214611

Hengartner, M.P. et al. (2021) ‘Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies’, Journal of Epidemiology & Community Health [Preprint]. Available at: https://doi.org/10.1136/jech-2020-214611.

M. P. Hengartner, S. Amendola, J. A. Kaminski, S. Kindler, T. Bschor, and M. Plöderl, “Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies,” Journal of Epidemiology & Community Health, 2021, doi: 10.1136/jech-2020-214611.

HENGARTNER, Michael Pascal, Simone AMENDOLA, Jakob A. KAMINSKI, Simone KINDLER, Tom BSCHOR und Martin PLÖDERL, 2021. Suicide risk with selective serotonin reuptake inhibitors and other new-generation antidepressants in adults: a systematic review and meta-analysis of observational studies. Journal of Epidemiology & Community Health. 2021. DOI 10.1136/jech-2020-214611

Hengartner, Michael Pascal, Simone Amendola, Jakob A. Kaminski, Simone Kindler, Tom Bschor, and Martin Plöderl. 2021. “Suicide Risk with Selective Serotonin Reuptake Inhibitors and Other New-Generation Antidepressants in Adults: A Systematic Review and Meta-Analysis of Observational Studies.” Journal of Epidemiology & Community Health. https://doi.org/10.1136/jech-2020-214611.

Hengartner, Michael Pascal, et al. “Suicide Risk with Selective Serotonin Reuptake Inhibitors and Other New-Generation Antidepressants in Adults: A Systematic Review and Meta-Analysis of Observational Studies.” Journal of Epidemiology & Community Health, 2021, https://doi.org/10.1136/jech-2020-214611.