Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Suicidal Ideation and SSRIs

The journal of Psychotherapy and Psycosomatics has published two articles examining the association between suicidal ideation and prescription of selective serotonin reuptake inhibitors (SSRIs). PharmaTimes has also reported the publication of these articles.

The first article is a secondary analysis of a 12-week open study of fluoxetine. Analysis of the data found that 14.3% of individuals in the study who had no suicidal ideation at baseline reported it at least once during the course of the study.

The second article is an evaluation of the evidence supporting treatment of children and adolescents with SSRIs. The author found 10 studies comprising 2,046 patients who were treated with fluoxetine, paroxetine, sertraline or citalopram. An additional 6 studies were also found that were not published due to lack of efficacy or problematic side effects. The analysis found no data supporting the use of SSRIs, except for fluoxetine. The author concluded that SSRIs are second line for severe and resistant forms of adolescent depression.

Action: When prescribing SSRIs for the first time an assessment of suicide risk should undertaken and repeated periodically. Guidelines are available from the National Institute for Health and Clinical Excellence for depression in Adults and Children and Young People.

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