Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Mini-Review

Antidepressiva und Selbstgefährdung: ein Widerspruch?

Published Online:May 28, 2019https://doi.org/10.1024/1661-8157/a003235

Abstract

Zusammenfassung. Die Diskussion über das Auftreten von suizidalen Symptomen bzw. Suizid unter einer Antidepressivatherapie ist bereits jahrzehntealt. Sowohl die Fachwelt als auch die Laienpresse setzte sich mit dem Thema immer wieder kritisch auseinander. Die vorliegende Arbeit gibt einen Überblick über die aktuelle Evidenzlage: Zurzeit bestehen keine Hinweise für eine Erhöhung des Suizidrisikos. Hingegen wurde insbesondere bei Kindern, Jugendlichen und jungen Erwachsenen zu Beginn der Therapie eine höhere Rate an Suizidalitätssymptomen (Suizidgedanken, Suizidhandlungen) beobachtet. Diese Symptome waren gegenüber der Periode vor Einsetzen der Antidepressivatherapie nicht erhöht und nehmen im Verlauf der Therapie kontinuierlich ab. Zu Beginn der Behandlung ist deshalb eine besonders intensive Therapieführung nötig. Allgemein gilt, dass eine unterlassene Therapie einer Depression das grösste Risiko für einen Suizid darstellt.


Antidepressants and Suicidality: A Contradiction?

Abstract. In 2004, the European and American authorities released a black-box warning on antidepressants indicating an association with an increased risk of suicidality (suicidal ideation and behavior) in young people. Until today, this issue remained controversial. The present review gives an overview on the relationship between antidepressant therapy and the risk of suicide and suicidality, respectively: there is no evidence of an increased risk of suicide, but of an increased rate of suicidality during the first period after starting an antidepressant treatment in young patients. Importantly, this risk was not higher than before treatment initiation. However, an intensified supervision is needed especially during the first weeks of treatment. Finally, the risk posed by untreated depression is far greater than a risk associated with antidepressant treatment.


Résumé. La discussion sur l’apparition de symptômes suicidaires ou le suicide sous traitement antidépresseur dure depuis des décennies. Tant le monde professionnel que la presse profane n’ont cessé d’aborder le sujet d’un œil critique. Le présent document donne un aperçu des preuves actuelles: il n’y a actuellement aucune preuve d’une augmentation du risque de suicide. Cependant, un taux plus élevé de symptômes suicidaires (pensées suicidaires, actions suicidaires) a été observé chez les enfants, les adolescents et les jeunes adultes en particulier au début du traitement. Ces symptômes n’ont pas augmenté par rapport à la période précédant l’instauration du traitement antidépresseur et ont diminué continuellement au cours du traitement. C’est pourquoi une thérapie particulièrement intensive est nécessaire au début du traitement. En général, l’échec du traitement de la dépression représente le plus grand risque de suicide.

Bibliografie

  • Dasgupta K: Additional cases of suicidal ideation associated with fluoxetine (letters). Am J Psychiatry 1990; 147:1570. First citation in articleGoogle Scholar

  • Hoover CE: Additional cases of suicidal ideation associated with fluoxetine (letters). Am J Psychiatry 1990; 147:1570–1571. First citation in articleGoogle Scholar

  • Masand P, Gupta S, Dewan M: Suicidal ideation related to fluoxetine. N Engl J Med 1991; 324: 420. First citation in articleGoogle Scholar

  • Teicher MH, Glod C, Cole JO: Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry 1990; 147: 207–210. First citation in articleGoogle Scholar

  • Mann JJ, Goodwin FK, O’Brian CP, Robinson DS: Suicidal behavior and psychotropic medication. Accepted as a consensus statement by the ACNP Council March 2, 1992. Neuropsychopharmacology 1993; 8: 177–183. First citation in articleGoogle Scholar

  • Medicines and Healtcare products Regulatory Acency (MHRA): SSRI and venlafaxine use in children 2003; 29: 4. First citation in articleGoogle Scholar

  • Mann JJ, Emslie G, Baldessarini RJ, et al.: ACNP Task Force Report on SSRIs and suicidality in youth. Neuropsychopharmacology 2006; 31: 473–492. First citation in articleGoogle Scholar

  • Friedman RA, Leon AC: Expanding the black box – depression, antidepressants, and the risk of suicide. N Engl J Med 2007; 356: 2343–2346. First citation in articleGoogle Scholar

  • Gründer G, Meyer-Lindenberg A, Maier W: Stellungnahme Nummer 5 der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) zur ARD-Reportage «Gefährliche Glückspillen – Milliardenprofite mit Antidepressiva» vom 18. Februar 2013. https://www.psychiatriepraxis-muenchen.de/download/DGPPN_Stellungnahme_Gefahrliche_Glueckspillen.pdf?m=1369400279&; letzter Zugriff: 23.04.2019. First citation in articleGoogle Scholar

  • Mann JJ, Apter A, Bertolote J, et al.: Suicide prevention strategies: a systematic review. JAMA 294 2005; 16: 2064–2074. First citation in articleGoogle Scholar

  • Hatzinger M: Affektive Störungen im Alter. Schweiz Archiv Neurol Psychiat 2011; 162: 179–189. First citation in articleGoogle Scholar

  • Hättenschwiler J, Baumann P, Hatzinger M, et al.: Begünstigen Antidepressiva die Suizidalität und die Suizidrate von Depressiven? Schweiz Med Forum 2007; 7: 757–764. First citation in articleGoogle Scholar

  • Fergusson D, Doucette S, Cranley Glass K: Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ. 2005; 330: 396. First citation in articleGoogle Scholar

  • Gunnell D, Saperia J, Ashby D: Selective serotonin reuptake inhibitors (SSRIs) and suicide in adults: meta-analysis of drug company data from placebo controlled, randomised controlled trials submitted to the MHRA’s safety review. BMJ. 2005; 19: 385–388. First citation in articleGoogle Scholar

  • Hammad TA, Laughren TP, Racoosin JA: Suicide rates in short-term randomized controlled trials of newer antidepressants. J Clin Psychopharmacol 2006; 26: 203–207. First citation in articleGoogle Scholar

  • Stone M, Laughren T, Jones ML, et al.: Temple R, Rochester G: Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration. BMJ 2009; 339: b2880. First citation in articleGoogle Scholar

  • Gibbons RD, Brown H, Hur K, Davis JM, Mann J: Suicidal thoughts and behavior with antidepressant treatment: Reanalysis of the randomized placebo-controlled studies of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012; 69: 580–587. First citation in articleGoogle Scholar

  • Valuck RJ, Libby AM, Andreson HD, et al.: Comparison of antidepressant classes and the risk and time course of suicide attempts in adults: propensity matched, retrospective cohort study. British J Psychiatry 2016; 208: 271–279. First citation in articleGoogle Scholar

  • Simon GE, Savarino J, Operskalski B, Wang PS: Suicide risk during antidepressant treatment. Am J Psychiatry 2006; 163: 41–47. First citation in articleGoogle Scholar

  • Cheung K, Aarts N, Noordam R, et al.: Antidepressant use and the risk of suicide: a population-based cohort study. J Affect Disorders 2015; 174:479–484. First citation in articleGoogle Scholar

  • Coupland C, Hill T, Morriss R, Arthur A, Moore M, Hippisley-Cox J: Antidepressant use and risk of suicide and attempted suicide or self-harm in people aged 20 to 64: cohort study using a primary care database. BMJ 2015; 350: h517. doi: 10.1136/bmj.h517 First citation in articleGoogle Scholar

  • Geddes JR, Barbui C, Cipriani A: Risk of suicidal behaviour in adults taking antidepressants. BMJ 2009; 339: b3066. First citation in articleGoogle Scholar

  • Rutz W, von Knorring L, Wålinder J: Frequency of suicide on Gotland after systematic postgraduate education of general practitioners. Acta Psychiatr Scand 1989; 80: 151–154. First citation in articleGoogle Scholar

  • Rhimer Z, Rutz W, Pihlgren H: Depression and suicide in Gotland. An intensive study of all suicides before and after a depression-training programme for general practitioners. J Affect Disord 1995; 35: 147–152. First citation in articleGoogle Scholar

  • Rutz W: Preventing suicide and premature death by education and treatment. J Affect Disord 2001; 62: 123–129. First citation in articleGoogle Scholar

  • Gunnel D, Ashby D: Antidepressants and suicide: what is the balance of benefit and harm. BMJ 2004; 329: 34–38. First citation in articleGoogle Scholar

  • Joyce PR: Improvements in the recognition and treatment of depression and decreasing suicide rates. N Z Med J 2001; 114: 535–536. First citation in articleGoogle Scholar

  • Hall WD, Mant A, Mitchell PB, Rendle VA, Hickie IB, McManus P: Association between antidepressant prescribing and suicide in Australia, 1991–2000: trend analysis. BMJ 2003; 326: 1008. First citation in articleGoogle Scholar

  • Grunebaum MF, Ellis SP, Li S, Oquendo MA, Mann JJ: Antidepressants and suicide risk in the United States, 1985–1999. J Clin Psychiatry 2004; 65: 1456–1462. First citation in articleGoogle Scholar

  • Søndergård L, Kvist K, Lopez AG, Andersen PK, Kessing LV: Temporal changes in suicide rates for persons treated and not treated with antidepressants in Denmark during 1995–1999. Acta Psychiatr Scand 2006; 114: 168–176. First citation in articleGoogle Scholar

  • Bramness JG, Walby FA, Tverdal A: The sales of antidepressants and suicide rates in Norway and its counties 1980 – 2004. J Affect Disord 2007; 102: 1–9. First citation in articleGoogle Scholar

  • Barbui C, Campomori A, D’Avanzo B, Negri E, Garattini S: Antidepressant drug use in Italy since the introduction of SSRIs: national trends, regional differences and impact on suicide rates. Soc Psychiatry Psychiatr Epidemiol 1999; 34: 152–156. First citation in articleGoogle Scholar

  • Kamat MA, Edgar L, Niblock P, McDowell C, Kelly CB: Association between antidepressant prescribing and suicide rates in OECD countries: An ecological study. Pharmacopsychiatry 2014; 47: 18–21. First citation in articleGoogle Scholar

  • Isacsson G, Bergman U, Rich CL: Epidemiological data suggest antidepressants reduce suicide risk among depressives. J Affective Disord 1996; 41: 1–8. First citation in articleGoogle Scholar

  • Isacsson G, Holgren P, Druid H, Bergman U: Psychotropics and suicide prevention. BJP 1999; 174: 259–265. First citation in articleGoogle Scholar

  • Isacsson G, Holmgren P, Ahlner J: Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14 857 suicides. Acta Psychiatr Scand 2005; 111: 286–290. First citation in articleGoogle Scholar

  • Brent DA, Birmaher B: British warnings on SSRIs questioned. J Am Acad Child Adolesc Psychiatry 2004; 43: 379–380. First citation in articleGoogle Scholar

  • Wohlfahrt TD, van Zwieten BJ, Lekkerkerker FJ: Antidepressants use in children and adolescents and the risk of suicide. Europ Neuropsychopharmacol 2006; 16: 79–83. First citation in articleGoogle Scholar

  • Hammad TA, Laughren T, Racoosin J: Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006; 63: 332–339. First citation in articleGoogle Scholar

  • Hetrik SE, McKenzie JE, Cox GR, Simmons MB, Merry SN: Newer generation antidepressants for depressive disorders in children and adolescents (review). Cochrane Database Syst Rev. 2012; 11: CD004851. First citation in articleGoogle Scholar

  • Bridge JA, Iyengar S, Salaray CB, et al.: Clincial response and risk for suicidal ideation and suicide attempts in pediatric antidepressant treatment. JAMA 2007; 297: 1683–1696. First citation in articleGoogle Scholar

  • Termorshuizen F, Palmen SJM, Heerdink ER: Suicide behavior before and after the start with antidepressants: A high persistent risk in the first month of treatment among young. Int J Neuropsychopharmacol 2015; 19: 1–10. First citation in articleGoogle Scholar

  • Olfson M, Shaffer D, Marcus SC, Greenberg T: Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry 2003; 60: 978–982. First citation in articleGoogle Scholar

  • Kelly CB, Ansari T, Rafferty T, Stevenson M: Antidepressant prescribing and suicide rate in Northern Ireland. European Psychiatry 2003; 18: 325–328. First citation in articleGoogle Scholar

  • Isacsson G, Ahlner J: Antidepressants and the risk of suicide in young persons – prescription trends and toxicological analyses. Acta Psychiatr Scand 2014; 129: 296–302. First citation in articleGoogle Scholar

  • Lieb R, Isensee B, Höfler M, Wittchen HU: Parental depression and depression in offspring: evidence for familial characteristics and subtypes? J Psychiatr Res 2002; 36: 237–246. First citation in articleGoogle Scholar

  • Lieb R, Bronisch T, Hofler M, Schreier A, Wittchen HU: Maternal suicidality and risk of suicidality in offspring: findings from a community study. Am J Psychiatry 2005; 162: 1665–1671. First citation in articleGoogle Scholar

  • Musil R, Zill P, Seemüller F,, et al.: Genetics of emergent suicidality during antidepressive treatment – Data from a naturalistic study on a large sample of inpatients with major depressive episode. Europ Neuropsychopharmacology 2013; 23: 663–674. First citation in articleGoogle Scholar

  • Laje G, Paddock S, Manji H, et al.: Genetic markers of suicidal ideation emerging during citalopram treatment of major depression. Am J Psychiatry 2007; 164: 1530–1538. First citation in articleGoogle Scholar

  • Menke A, Lucae S, Kloiber S, et al.: Genetic markers within the glutamate receptors associated with antidepressant treatment-emergent suicidal ideation. 2008; 165: 917–918. First citation in articleGoogle Scholar

  • Grunebaum MF, Galfalvy HC, Choo TH, et al.: Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial. 2008; 175: 327–335. First citation in articleGoogle Scholar

  • Holsboer F, Ising M: Stress hormone regulation: Biological role and translation into therapy. Annu Rev Psychol 2010; 61: 81–109. First citation in articleGoogle Scholar

  • Hatzinger M, Hemmeter UM, Baumann K, Brand S, Holsboer-Trachsler E: The combined DEX-CRH test in treatment course and long-term outcome of major depression. J Psychiatric Res 2002; 36: 287–297. First citation in articleGoogle Scholar

  • Coryell W, Schlesser M: The dexamethasone suppression test and suicide prediction, Am J Psychiatry 2001; 158: 748–753. First citation in articleGoogle Scholar

  • De Kloet R, Joëls M, Holsboer F: Stress and the brain: From adaptation to disease. Nature Rev Neuroscience 2005; 6: 463–475. First citation in articleGoogle Scholar

  • Brent D, Melhem N, Ferrell R, et al.: Association of FKBP5 polymorphisms with suicidal events in the Treatment of Resistant Depression in Adolescents (TORDIA) study. Am J Psychiatry 2010; 167: 190–197. First citation in articleGoogle Scholar

  • Perroud N, Uher R, Ng MYM, et al.: Genome-wide association study of increasing suicidal ideation during antidepressant treatment in the GENDEP project. The Pharmacogenomics Journal 2012; 12: 68–77. First citation in articleGoogle Scholar

  • Menke A, Domschke K, Czamara D, et al.: Genome-wide association study of antidepressant treatment-emergent suicidal ideation. Neuropsychopharmacology 2012; 37: 797–807. First citation in articleGoogle Scholar

  • Arzneimittel-Kompendium der Schweiz [Online]. 2018. https://compendium.ch/home/de; letzter Zugriff: 03.03.2019. First citation in articleGoogle Scholar

  • 60. Cipriani A, Furukawa TA, Salanti G, et al.: Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018; 391: 1357–1366. First citation in articleGoogle Scholar

  • 61. Libby AM, Orton HD, Valuck RJ: Persistent decline in depression treatment after FDA warnings. Arch Gen Psychiatry 2009; 66: 633–639. First citation in articleGoogle Scholar

  • 62. Friedman RA: Antidepressants’ black-box warning – 10 years later. N Engl J Med 2014; 371: 1666–1668. First citation in articleGoogle Scholar

  • 63. Stone MB: The FDA Warning on antidepressants and suicidality – Why the controversy? N Engl J Med 2014; 371: 1668–1671. First citation in articleGoogle Scholar