Suicidality | Black Box Warning | Pregnancy and Lactation | Fractures | SSRI Discontinuation Syndrome | Overdose
Evidence implicating 5-HT in suicide or violence is compelling.
Reduced CSF 5-HIAA concentrations correlate highly with completed
suicides in patients with depression (Edman et al. 1986; Ninan et al. 1984). In vitro binding assays have shown an increased
density (Bmax) of 5-HT2 receptors
in individuals with depression and suicidal tendencies (Pandey et al. 1990). Both observations are consistent with a relative
state of 5-HT depletion among subjects with suicidal tendencies.
The American College of Neuropsychopharmacology (1992)
reviewed evidence showing that antidepressants result in substantial
improvement or remission of suicidal ideation and impulses in the
vast majority of patients. SSRIs were thought to potentially "carry
a lower risk for suicide than older tricyclic antidepressants" (p.
181) when taken in overdose. Furthermore, the task force stated
that no evidence indicated that SSRIs triggered emergent suicidal
ideation above base rates associated with depression. In addition, Warshaw and Keller (1996) determined that fluoxetine use did not
increase the rate of suicide in a group of 654 patients with anxiety
disorders. In a large retrospective review of patients receiving
one or more of 10 antidepressants (including fluoxetine), Jick et al. (1995) concluded that the risk for suicide was similar
among all agents.