1
|
Li Y, Chen C, Chen Q, Yuan S, Liang W, Zhu Y, Zhang B. Effects of selective serotonin reuptake inhibitors (SSRIs) on suicide: A network meta-analysis of double-blind randomized trials. Psychiatry Res 2024; 336:115917. [PMID: 38663222 DOI: 10.1016/j.psychres.2024.115917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 04/03/2024] [Accepted: 04/13/2024] [Indexed: 05/07/2024]
Abstract
The relationship between the use of selective serotonin reuptake inhibitors (SSRIs) and suicide risk in patients with mental disorders remains controversial. We conducted a network meta-analysis to examine the effects of SSRIs on suicide risk in patients with mental disorders. A comprehensive search was conducted across PubMed, Web of Science, PsycINFO, CENTRAL, Wanfang Database, and China National Knowledge Infrastructure for articles published until December 19, 2023. The main outcomes were suicidal ideation and instances of suicidal behavior. We included 29 double-blind randomized trials in our analysis. The findings suggest that SSRIs primarily offer short-term protection against suicidal ideation. By week 2, paroxetine, fluoxetine, escitalopram, and non-SSRI treatments were linked to a decreased suicide risk compared with a placebo, with the exception of sertraline. This protective effect was diminished by week 8. In contrast, studies on instances of suicidal behavior from weeks 1 to 10 found no significant difference in efficacy between SSRIs, non-SSRIs, and placebo. These results indicate that SSRIs may offer short-term protection against suicidal ideation. However, their long-term effectiveness in mitigating suicidal ideation and preventing suicidal behaviors is limited.
Collapse
Affiliation(s)
- Yuling Li
- The Mental Health College of Guangzhou Medical University, Guangzhou, PR China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Chengfeng Chen
- The Mental Health College of Guangzhou Medical University, Guangzhou, PR China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Qinghua Chen
- The Mental Health College of Guangzhou Medical University, Guangzhou, PR China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Shiqi Yuan
- The Mental Health College of Guangzhou Medical University, Guangzhou, PR China; Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Wanyuan Liang
- Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, PR China
| | - Yikang Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Bin Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, PR China.
| |
Collapse
|
2
|
Sefid Fard Jahromi M, Eghbal MH, Rahmanian V. Epidemiology of suicide and suicide attempts in Jahrom district, Southern Iran in light of COVID pandemic: A prospective observational study. Health Sci Rep 2022; 5:e933. [PMCID: PMC9662693 DOI: 10.1002/hsr2.933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mina Sefid Fard Jahromi
- Psychiatry, Research Center for Non‐Communicable Diseases Jahrom University of Medical Sciences Jahrom Iran
| | - Mohammad Hadi Eghbal
- Faculty of Medicine, Research Center for Social Determinants of Health Jahrom University of Medical Sciences Jahrom Iran
| | - Vahid Rahmanian
- Epidemiology, Research Center for Social Determinants of Health Jahrom University of Medical Sciences Jahrom Iran
| |
Collapse
|
3
|
Thiele LS, Ishtiak-Ahmed K, Thirstrup JP, Agerbo E, Lunenburg CATC, Müller DJ, Gasse C. Clinical Impact of Functional CYP2C19 and CYP2D6 Gene Variants on Treatment with Antidepressants in Young People with Depression: A Danish Cohort Study. Pharmaceuticals (Basel) 2022; 15:ph15070870. [PMID: 35890168 PMCID: PMC9318115 DOI: 10.3390/ph15070870] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background: The clinical impact of the functional CYP2C19 and CYP2D6 gene variants on antidepressant treatment in people with depression is not well studied. Here, we evaluate the utility of pharmacogenetic (PGx) testing in psychiatry by investigating the association between the phenotype status of the cytochrome P450 (CYP) 2C19/2D6 enzymes and the one-year risks of clinical outcomes in patients with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine. Methods: This study is a population-based cohort study of 17,297 individuals who were born between 1981 and 2005 with a depression diagnosis between 1996 and 2012. Using array-based single-nucleotide-polymorphism genotype data, the individuals were categorized according to their metabolizing status of CYP2C19/CYP2D6 as normal (NM, reference group), ultra-rapid- (UM), rapid- (RM), intermediate- (IM), or poor-metabolizer (PM). The outcomes were treatment switching or discontinuation, psychiatric emergency department contacts, and suicide attempt/self-harm. By using Poisson regression analyses, we have estimated the incidence rate ratios (IRR) with 95% confidence intervals (95% CI) that were adjusted for covariates and potential confounders, by age groups (<18 (children and adolescents), 19−25 (young adults), and 26+ years (adults)), comparing the outcomes in individuals with NM status (reference) versus the mutant metabolizer status. For statistically significant outcomes, we have calculated the number needed to treat (NNT) and the number needed to genotype (NNG) in order to prevent one outcome. Results: The children and adolescents who were using (es)citalopram with CYP2C19 PM status had increased risks of switching (IRR = 1.64 [95% CI: 1.10−2.43]) and suicide attempt/self-harm (IRR = 2.67 [95% CI; 1.57−4.52]). The young adults with CYP2C19 PM status who were using sertraline had an increased risk of switching (IRR = 2.06 [95% CI; 1.03−4.11]). The young adults with CYP2D6 PM status who were using fluoxetine had an increased risk of emergency department contacts (IRR = 3.28 [95% CI; 1.11−9.63]). No significant associations were detected in the adults. The NNG for preventing one suicide attempt/suicide in the children who were using (es)citalopram was 463, and the NNT was 11. Conclusion: The CYP2C19 and CYP2D6 PM phenotype statuses were associated with outcomes in children, adolescents, and young adults with depression with incident new-use of (es)citalopram, sertraline, or fluoxetine, therefore indicating the utility of PGx testing, particularly in younger people, for PGx-guided antidepressant treatment.
Collapse
Affiliation(s)
- Liv S. Thiele
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
| | - Kazi Ishtiak-Ahmed
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Janne P. Thirstrup
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research (NCRR), Aarhus BSS, Aarhus University, 8210 Aarhus, Denmark;
- Centre for Integrated Register-Based Research Aarhus University (CIRRAU), 8210 Aarhus, Denmark
| | - Carin A. T. C. Lunenburg
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Daniel J. Müller
- Pharmacogenetics Research Clinic, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada;
- Department of Psychiatry, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Christiane Gasse
- Department of Affective Disorders, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark; (L.S.T.); (K.I.-A.); (J.P.T.); (C.A.T.C.L.)
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, 8200 Aarhus, Denmark
- Correspondence: ; Tel.: +45-51191476
| |
Collapse
|