Talking Points About Antidepressants and Suicide

Thomas A. M. Kramer, MD

Disclosures
In This Article

Introduction

Many people have asked me for advice about how to respond to questions from patients and the lay public about the recent press, and ultimately US Food and Drug Administration (FDA) warnings, about suicidality and antidepressants. I thought it might be helpful to the readership to present some talking points about this issue which may be used in responding to these questions.

The first issue that I would suggest addressing is the one of scale. Fluoxetine became available in 1987, and other selective serotonin reuptake inhibitors (SSRIs) became available shortly thereafter. In the 17 or so years that we are talking about here, there have been millions -- if not tens of millions -- of prescriptions resulting in numerous satisfied patients and practitioners. If SSRI-associated suicidality truly is a major problem, it is difficult to understand why it is coming to light now. This idea was discussed in a few studies in the early 1990s, but these were dismissed as exceptional cases. It is not at all clear why this is becoming an issue all of a sudden in 2004.

It must be emphasized how important the newer generation of antidepressants has been in improving the lives of many individuals. These medications, despite their current negative press, have been enormously effective in reducing the burden of depression. Their side-effect profile is relatively low (although certainly not zero) and they are considerably safer in overdose than their predecessors, making them considerably less risky for suicide.

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