Möller Hans-Jürgen
Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336, Munich, Germany.
Eur Arch Psychiatry Clin Neurosci. 2006 Sep;256(6):329-43. doi: 10.1007/s00406-006-0650-x. Epub 2006 Jun 16.
The role of antidepressants in suicide prevention is a major public health question, given the high prevalence of both depression and depression-related suicidality. Therefore all means available should be utilised to clarify the influence of antidepressants on suicidality. This paper gives a comprehensive overview of the positive effects of antidepressants on suicidality. In the first section, principal methodological issues related to suicidology in general as well as to clinical and epidemiological studies that investigate the influence of antidepressants on suicidality are discussed. In the second section, the results of controlled clinical studies on the efficacy of antidepressants in suicidality are presented. The third section reports on the results of other types of studies, especially epidemiological studies. Altogether, there seems to be reasonable evidence from different research approaches that antidepressants are able to reduce suicidal ideation and also suicidal behaviour in depressive patients. While the evidence for the beneficial effect on suicidal ideation comes from randomised control group studies, some of which used a placebo arm, the evidence for the prophylactic effect on suicidal behaviour, especially suicide, was primarily obtained from well-designed epidemiological studies.
鉴于抑郁症及与抑郁相关的自杀倾向的高发病率，抗抑郁药在预防自杀方面的作用是一个重大的公共卫生问题。因此，应利用一切可用手段来阐明抗抑郁药对自杀倾向的影响。本文全面概述了抗抑郁药对自杀倾向的积极作用。在第一部分，讨论了与自杀学总体相关的主要方法问题，以及调查抗抑郁药对自杀倾向影响的临床和流行病学研究相关的问题。在第二部分，介绍了关于抗抑郁药对自杀倾向疗效的对照临床研究结果。第三部分报告了其他类型研究的结果，特别是流行病学研究的结果。总体而言，来自不同研究方法的合理证据表明，抗抑郁药能够减少抑郁症患者的自杀意念以及自杀行为。虽然对自杀意念有益作用的证据来自随机对照组研究，其中一些研究使用了安慰剂组，但对自杀行为（尤其是自杀）预防作用的证据主要来自精心设计的流行病学研究。
