TO THE END? –
March 15, 2021 – According to Hengartner et al., the last meta-analysis that included observational studies was published in 2009, included only eight studies with about 200,000 participants, and did not include non-SSRI antidepressants like venlafaxine, bupropion, and mirtazapine. That study was also unable to control for publication bias and the bias of studies funded by the pharmaceutical industry (fCOI).
That 2009 study concluded that the risk of suicide was nearly doubled in adolescents taking SSRIs but that the drugs do reduce suicide risk in adults. However, that study was limited by smaller size, not controlling for biases, and not including all the drugs that are considered antidepressants.
Hengartner et al., have now updated that study, including 27 studies with 1.45 million participants, including non-SSRI antidepressants and antidepressants being used for indications other than depression, and controlling for biases like selective publication and studies sponsored by the pharmaceutical industry.
They found that antidepressants were associated with increased suicide risk in adults as well as adolescents. Moreover, even considering SSRIs alone did not reduce suicide risk—at best, suicide risk stayed the same.
“Contrary to prominent claims, we find no reliable evidence that antidepressants protect against suicide. Instead, it appears that antidepressant use may even increase suicide risk.”
Hengartner et al. were also able to assess the effect of publication bias and fCOI on the results. When they controlled for these biases, the results were even stronger, and even SSRIs were significantly associated with increased suicidality. Studies funded by the pharmaceutical industry were far more likely to find lower suicide rates than studies performed by independent researchers. Studies that make antidepressants look poor are far less likely to be published.
