Evidence map›Paper›PMID 19188627›Full record

SynthesisCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2009

Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies.

Corrado Barbui, Eleonora Esposito, Andrea Cipriani

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 89 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
89citing papers in PubMed, 10 pooled it
20.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

89 citing papers in PubMed, 10 syntheses or guidelines pooled it, 273 citations in OpenAlex.

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  6. Item-based analysis of the effects of duloxetine in depression: a patient-level post hoc study.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2020
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  19. Antidepressants in the treatment of bipolar depression: commentary.The international journal of neuropsychopharmacology · 2025
    Review
  20. Suicide prevention: what works, what might work, and what does not work.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2025
    Article

29 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors at 1 institution in 1 country.

Corrado BarbuiWorld Health Organization Collaborating Centre for Research and Training in Mental Health, Department of Medicine and Public Health, Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy.
Eleonora Esposito
Andrea Cipriani
University of Verona · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIt is unclear whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressant drugs reduce the risk of suicide in people with depression. We explored the association between exposure to SSRIs and risk of suicide completion or attempt.

methodsWe conducted a systematic review of observational studies that reported completed or attempted suicide in depressed individuals who were exposed to SSRIs compared with those who were not exposed to antidepressants. We assessed the overall risk of completed or attempted suicide.

resultsEight studies involving more than 200 000 patients with moderate or severe depression were included in the meta-analysis. Although exposure to SSRIs increased the risk of completed or attempted suicide among adolescents (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.51-2.44), the risk was decreased among adults (OR 0.57, 95% CI 0.47-0.70). Among people aged 65 or more years, exposure to SSRIs had a protective effect (OR 0.46, 95% CI 0.27-0.79). Sensitivity analyses did not change these findings. In particular, for studies that used completed suicide as an outcome, exposure to SSRIs was associated with increased risk among adolescents (OR 5.81, 95% CI 1.57-21.51) and decreased risk among adults (OR 0.66, 95% CI 0.52-0.83) and older people (OR 0.53, 95% CI 0.26-1.06).

interpretationBased on data from observational studies, use of SSRIs may be associated with a reduced risk of suicide in adults with depression. Among adolescents, use of SSRIs may increase suicidality.

Indexed as

SuicideAdolescentAdolescent BehaviorAge FactorsConfidence IntervalsDepressionHumansOdds RatioRisk AssessmentSelective Serotonin Reuptake InhibitorsSelective Serotonin Reuptake Inhibitors

Identifiers

PMID19188627
PMCPMC2630355
OpenAlexW2120590819

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.