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BMJ. 1991 September 21; 303(6804): 685–692.
PMCID: PMC1670974

Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression.

Abstract

OBJECTIVE--A comprehensive meta-analysis of clinical trial data was performed to assess the possible association of fluoxetine and suicidality (suicidal acts and ideation). DESIGN--Retrospective analysis of pooled data from 17 double blind clinical trials in patients with major depressive disorder comparing fluoxetine (n = 1765) with a tricyclic antidepressant (n = 731) or placebo (n = 569), or both. MAIN OUTCOME MEASURES--Multiple data sources were searched to identify patients with suicidal acts. Suicidal ideation was assessed with item 3 of the Hamilton depression rating scale, which systematically rates suicidality. Emergence of substantial suicidal ideation was defined as a change in the rating of this item from 0 or 1 at baseline to 3 or 4 during double blind treatment; worsening was defined as any increase from baseline; improvement was defined as a decrease from baseline at the last visit during the treatment. RESULTS--Suicidal acts did not differ significantly in comparisons of fluoxetine with placebo (0.2% v 0.2%, p = 0.494, Mantel-Haenszel adjusted incidence difference) and with tricyclic antidepressants (0.7% v 0.4%, p = 0.419). The pooled incidence of suicidal acts was 0.3% for fluoxetine, 0.2% for placebo, and 0.4% for tricyclic antidepressants, and fluoxetine did not differ significantly from either placebo (p = 0.533, Pearson's chi 2) or tricyclic antidepressants (p = 0.789). Suicidal ideation emerged marginally significantly less often with fluoxetine than with placebo (0.9% v 2.6%, p = 0.094) and numerically less often than with tricyclic antidepressants (1.7% v 3.6%, p = 0.102). The pooled incidence of emergence of substantial suicidal ideation was 1.2% for fluoxetine, 2.6% for placebo, and 3.6% for tricyclic antidepressants. The incidence was significantly lower with fluoxetine than with placebo (p = 0.042) and tricyclic antidepressants (p = 0.001). Any degree of worsening of suicidal ideation was similar with fluoxetine and placebo (15.4% v 17.9%, p = 0.196) and with fluoxetine and tricyclic antidepressants (15.6% v 16.3%, p = 0.793). The pooled incidence of worsening of suicidal ideation was 15.3% for fluoxetine, 17.9% for placebo, and 16.3% for tricyclic antidepressants. The incidence did not differ significantly with fluoxetine and placebo (p = 0.141) or tricyclic antidepressants (p = 0.542). Suicidal ideation improved significantly more with fluoxetine than with placebo (72.0% v 54.8%, p less than 0.001) and was similar to the improvement with tricyclic antidepressants (72.5% v 69.8%, p = 0.294). The pooled incidence of improvement of suicidal ideation was 72.2% for fluoxetine, 54.8% for placebo, and 69.8% for tricyclic antidepressants. The incidence with fluoxetine was significantly greater than with placebo (p less than 0.001) and did not differ from that with tricyclic antidepressants (p = 0.296). CONCLUSIONS--Data from these trials do not show that fluoxetine is associated with an increased risk of suicidal acts or emergence of substantial suicidal thoughts among depressed patients.

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Selected References

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  • Damluji NF, Ferguson JM. Paradoxical worsening of depressive symptomatology caused by antidepressants. J Clin Psychopharmacol. 1988 Oct;8(5):347–349. [PubMed]
  • Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry. 1990 Feb;147(2):207–210. [PubMed]
  • King RA, Riddle MA, Chappell PB, Hardin MT, Anderson GM, Lombroso P, Scahill L. Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment. J Am Acad Child Adolesc Psychiatry. 1991 Mar;30(2):179–186. [PubMed]
  • Hoover CE. Suicidal ideation not associated with fluoxetine. Am J Psychiatry. 1991 Apr;148(4):543–543. [PubMed]
  • Fava M, Rosenbaum JF. Suicidality and fluoxetine: is there a relationship? J Clin Psychiatry. 1991 Mar;52(3):108–111. [PubMed]
  • Montgomery SA, Pinder RM. Do some antidepressants promote suicide? Psychopharmacology (Berl) 1987;92(2):265–266. [PubMed]
  • Muijen M, Roy D, Silverstone T, Mehmet A, Christie M. A comparative clinical trial of fluoxetine, mianserin and placebo in depressed outpatients. Acta Psychiatr Scand. 1988 Sep;78(3):384–390. [PubMed]
  • Rouillon F, Phillips R, Serrurier D, Ansart E, Gérard MJ. Rechutes de dépression unipolaire et efficacité de la maprotiline. Encephale. 1989 Nov-Dec;15(6):527–534. [PubMed]
  • Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. 1967 Dec;6(4):278–296. [PubMed]
  • Guze SB, Robins E. Suicide and primary affective disorders. Br J Psychiatry. 1970 Oct;117(539):437–438. [PubMed]
  • Johnson J, Weissman MM, Klerman GL. Panic disorder, comorbidity, and suicide attempts. Arch Gen Psychiatry. 1990 Sep;47(9):805–808. [PubMed]
  • Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D, Gibbons R. Time-related predictors of suicide in major affective disorder. Am J Psychiatry. 1990 Sep;147(9):1189–1194. [PubMed]
  • Paykel ES, Myers JK, Lindenthal JJ, Tanner J. Suicidal feelings in the general population: a prevalence study. Br J Psychiatry. 1974 May;124(0):460–469. [PubMed]
  • Simeon JG, Dinicola VF, Ferguson HB, Copping W. Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacol Biol Psychiatry. 1990;14(5):791–795. [PubMed]
  • Fabre LF, Putman HP., 3rd A fixed-dose clinical trial of fluoxetine in outpatients with major depression. J Clin Psychiatry. 1987 Oct;48(10):406–408. [PubMed]
  • Dunlop SR, Dornseif BE, Wernicke JF, Potvin JH. Pattern analysis shows beneficial effect of fluoxetine treatment in mild depression. Psychopharmacol Bull. 1990;26(2):173–180. [PubMed]
  • Fieve RR, Goodnick PJ, Peselow ED, Barouche F, Schlegel A. Pattern analysis of antidepressant response to fluoxetine. J Clin Psychiatry. 1986 Nov;47(11):560–562. [PubMed]
  • Wernicke JF, Dunlop SR, Dornseif BE, Bosomworth JC, Humbert M. Low-dose fluoxetine therapy for depression. Psychopharmacol Bull. 1988;24(1):183–188. [PubMed]
  • Bremner JD. Fluoxetine in depressed patients: a comparison with imipramine. J Clin Psychiatry. 1984 Oct;45(10):414–419. [PubMed]
  • Feighner JP, Cohn JB. Double-blind comparative trials of fluoxetine and doxepin in geriatric patients with major depressive disorder. J Clin Psychiatry. 1985 Mar;46(3 Pt 2):20–25. [PubMed]
  • Feighner JP. A comparative trial of fluoxetine and amitriptyline in patients with major depressive disorder. J Clin Psychiatry. 1985 Sep;46(9):369–372. [PubMed]
  • Chouinard G. A double-blind controlled clinical trial of fluoxetine and amitriptyline in the treatment of outpatients with major depressive disorder. J Clin Psychiatry. 1985 Mar;46(3 Pt 2):32–37. [PubMed]
  • Byerley WF, Reimherr FW, Wood DR, Grosser BI. Fluoxetine, a selective serotonin uptake inhibitor, for the treatment of outpatients with major depression. J Clin Psychopharmacol. 1988 Apr;8(2):112–115. [PubMed]
  • Beasley CM, Jr, Sayler ME, Bosomworth JC, Wernicke JF. High-dose fluoxetine: efficacy and activating-sedating effects in agitated and retarded depression. J Clin Psychopharmacol. 1991 Jun;11(3):166–174. [PubMed]
  • Cohn JB, Wilcox C. A comparison of fluoxetine, imipramine, and placebo in patients with major depressive disorder. J Clin Psychiatry. 1985 Mar;46(3 Pt 2):26–31. [PubMed]
  • Reimherr FW, Wood DR, Byerley B, Brainard J, Grosser BI. Characteristics of responders to fluoxetine. Psychopharmacol Bull. 1984 Winter;20(1):70–72. [PubMed]
  • Feighner JP, Boyer WF, Merideth CH, Hendrickson GG. A double-blind comparison of fluoxetine, imipramine and placebo in outpatients with major depression. Int Clin Psychopharmacol. 1989 Apr;4(2):127–134. [PubMed]
  • Cohn JB, Collins G, Ashbrook E, Wernicke JF. A comparison of fluoxetine imipramine and placebo in patients with bipolar depressive disorder. Int Clin Psychopharmacol. 1989 Oct;4(4):313–322. [PubMed]

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