SynthesisBMJ (Clinical research ed.)2009
Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration.
Synthesis in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 203 papers, 21 of them syntheses that pooled 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.
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.
Who cites it
203 citing papers in PubMed, 21 syntheses or guidelines pooled it, 601 citations in OpenAlex.
- Efficacy of racemic ketamine or esketamine monotherapy for reducing suicidal ideation in uni- or bipolar depression: a systematic review and meta-analysis.European archives of psychiatry and clinical neuroscience · 2025Pooled it
- Pooled it
- Assessing the Labeling Information on Drugs Associated With Suicide Risk: Systematic Review.JMIR public health and surveillance · 2024Pooled it
- Risk of Suicidal Behaviors and Antidepressant Exposure Among Children and Adolescents: A Meta-Analysis of Observational Studies.Frontiers in psychiatry · 2022Pooled it
- Efficacy and Tolerability of Repetitive Transcranial Magnetic Stimulation on Suicidal Ideation: A Systemic Review and Meta-Analysis.Frontiers in psychiatry · 2022Pooled it
- Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review.The American journal of psychiatry · 2021Pooled it
- Pharmacological interventions for self-harm in adults.The Cochrane database of systematic reviews · 2021Pooled it
- Hiding negative trials by pooling them: a secondary analysis of pooled-trials publication bias in FDA-registered antidepressant trials.Psychological medicine · 2019Pooled it
- Pooled it
- Diving and antidepressants.Diving and hyperbaric medicine · 2017Guideline
- Effects of vilazodone on suicidal ideation and behavior in adults with major depressive disorder or generalized anxiety disorder: post-hoc analysis of randomized, double-blind, placebo-controlled trials.International clinical psychopharmacology · 2017Pooled it
- Discontinuation, Efficacy, and Safety of Cholinesterase Inhibitors for Alzheimer's Disease: a Meta-Analysis and Meta-Regression of 43 Randomized Clinical Trials Enrolling 16 106 Patients.The international journal of neuropsychopharmacology · 2017Pooled it
- Can systematic reviews contribute to regulatory decisions?European journal of clinical pharmacology · 2017Pooled it
- Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers.Journal of the Royal Society of Medicine · 2016Pooled it
- Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 3. Pharmacological Treatments.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2016Pooled it
- Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports.BMJ (Clinical research ed.) · 2016Pooled it
- Efficacy, safety and variability in pharmacotherapy for adults with attention deficit hyperactivity disorder: a meta-analysis and meta-regression in over 9000 patients.Psychopharmacology · 2016Pooled it
- The efficacy of paroxetine and placebo in treating anxiety and depression: a meta-analysis of change on the Hamilton Rating Scales.PloS one · 2014Pooled it
- The cost effectiveness of pharmacological treatments for generalized anxiety disorder.PharmacoEconomics · 2013Pooled it
- Newer generation antidepressants for depressive disorders in children and adolescents.The Cochrane database of systematic reviews · 2012Pooled it
143 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the risk of suicidal behaviour within clinical trials of antidepressants in adults.
designMeta-analysis of 372 double blind randomised placebo controlled trials.
settingDrug development programmes for any indication in adults.
participants99 231 adults assigned to antidepressants or placebo. Median age was 42 and 63.1% were women. Indications for treatment were major depression (45.6%), other depression (4.6%), other psychiatric disorders (27.6%), and non-psychiatric disorders (22.2%).
main outcome measuresSuicidal behaviour (completed suicide, attempted suicide, or preparatory acts) and ideation.
resultsFor participants with non-psychiatric indications, suicidal behaviour and ideation were extremely rare. For those with psychiatric indications, risk was associated with age. For suicidal behaviour or ideation and for suicidal behaviour only, the respective odds ratios were 1.62 (95% confidence interval 0.97 to 2.71) and 2.30 (1.04 to 5.09) for participants aged <25, 0.79 (0.64 to 0.98) and 0.87 (0.58 to 1.29) for those aged 25-64, and 0.37 (0.18 to 0.76) and 0.06 (0.01 to 0.58) for those aged >or=65. When age was modelled as a continuous variable, the odds ratio for suicidal behaviour or ideation declined at a rate of 2.6% per year of age (-3.9% to -1.3%, P=0.0001) and the odds ratio for suicidal behaviour declined at a rate of 4.6% per year of age (-7.4% to -1.8%, P=0.001).
conclusionsRisk of suicidality associated with use of antidepressants is strongly age dependent. Compared with placebo, the increased risk for suicidality and suicidal behaviour among adults under 25 approaches that seen in children and adolescents. The net effect seems to be neutral on suicidal behaviour but possibly protective for suicidal ideation in adults aged 25-64 and to reduce the risk of both suicidality and suicidal behaviour in those aged >or=65.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.