Observing time effect of SSRIs on suicide risk and suicide-related behaviour: a network meta-analysis protocol

Abstract

IntroductionSuicide is a serious problem worldwide and 90% cases are associated with pre-existing or underlying mental illness. As a common treatment for depressive symptoms that suicidal people may receive, selective serotonin reuptake inhibitors (SSRIs) have been linked to a possible increase in suicide rates. Studies focusing on SSRIs and suicide have produced inconsistent results, suggesting that use of SSRIs decreases, increases, has no effect on suicide rates, or that the effect of SSRIs on suicide is age-dependent. This protocol of network meta-analysis aims to precisely evaluate the time effects of SSRIs by observing weekly changes of suicidality in the first 2 months of the treatment, and consequently, to explore whether the effect of the SSRIs on suicide varies depending on the stages of the treatment; if so, we will identify the turning point.Methods and analysisWe will search in the following databases: PubMed, Web of science, China National Knowledge Infrastructure and Wanfang Data, from dates of inception to 9 July 2021, with language restricted to English and Chinese. Studies focusing on the time effect of SSRIs on suicide will be retrieved. Then, the study selection process will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, and the quality assessment will be conducted with Cochrane Collaboration’s tool. Two researchers will work independently on data extraction using a standardised data extraction spreadsheet. Any disagreement between two researchers will be discussed and determined by a third researcher.Ethics and disseminationThis work does not require ethics approval as it will be based on published studies. This review will be published in peer-reviewed journals.PROSPERO registration numberCRD42021244779.

Clinical Impact of Functional CYP2C19 and CYP2D6 Gene Variants on Treatment with Antidepressants in Young People with Depression: A Danish Cohort Study

“…Suicidal behavior is a feared and severe outcome in young patients using SSRIs [ 22 ]. We have detected a more than a 2-fold increased risk of suicide attempt/self-harm in the children and adolescents who were using (es)citalopram with poor metabolizing capacity.…”

“…By contrast, an international study of 243 patients found no differences between the phenotypes and suicidal behavior, as measured by clinical rating scales [ 24 ], while a post-mortem study showed an enrichment of CYP2C19 PMs and UMs among adult suicide victims who had tested positively for citalopram, compared with the population controls [ 25 ]. It should be noted that the use of (es)citalopram dropped to nearly 0 by 2021 [ 26 ] in children and adolescents since the warnings of the increased risk of suicidal behavior were issued in 2010 [ 22 ]. In 2021, fluoxetine and sertraline were the most frequently used antidepressants among children in Denmark [ 26 ].…”

“…Here, we have examined the association of CYP2C19 and CYP2D6 gene variants translated into PGx phenotypes with treatment outcomes of switching or discontinuation, psychiatric emergency department contacts, and suicide attempt/self-harm in patients with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine in children and adolescents (≤18 years), young adults (19)(20)(21)(22)(23)(24)(25), and adults (≥26 years).…”

“…Lunenburg of the Lundbeck foundation, Denmark (R322-2019-2404), and by L.S. Thiele of the Lundbeck foundation, Denmark (F-61171-[19][20][21][22][23][24][25][26][27]. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.…”

Epidemiology of suicide and suicide attempts in Jahrom district, Southern Iran in light of COVID pandemic: A prospective observational study

“…Many studies have been conducted on the effect of antidepressants in treating depression and preventing suicide, and completely different results have been extracted. Some studies have reported a positive effect, 47–49 and others have said an adverse effect or lack of effectiveness of these drugs 50–52 …”