Hengartner Michael P, Amendola Simone, Kaminski Jakob A, Kindler Simone, Bschor Tom, Plöderl Martin
Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Roma, Italy.
J Epidemiol Community Health. 2021 Mar 8. doi: 10.1136/jech-2020-214611.
There is ongoing controversy whether antidepressant use alters suicide risk in adults with depression and other treatment indications.
Systematic review of observational studies, searching MEDLINE, PsycINFO, Web of Science, PsycARTICLES and SCOPUS for case-control and cohort studies. We included studies on depression and various indications unspecified (including off-label use) reporting risk of suicide and/or suicide attempt for adult patients using selective serotonin reuptake inhibitors (SSRI) and other new-generation antidepressants relative to non-users. Effects were meta-analytically aggregated with random-effects models, reporting relative risk (RR) estimates with 95% CIs. Publication bias was assessed via funnel-plot asymmetry and trim-and-fill method. Financial conflict of interest (fCOI) was defined present when lead authors' professorship was industry-sponsored, they received industry-payments, or when the study was industry-sponsored.
We included 27 studies, 19 on depression and 8 on various indications unspecified (n=1.45 million subjects). SSRI were not definitely related to suicide risk (suicide and suicide attempt combined) in depression (RR=1.03, 0.70-1.51) and all indications (RR=1.19, 0.88-1.60). Any new-generation antidepressant was associated with higher suicide risk in depression (RR=1.29, 1.06-1.57) and all indications (RR=1.45, 1.23-1.70). Studies with fCOI reported significantly lower risk estimates than studies without fCOI. Funnel-plots were asymmetrical and imputation of missing studies with trim-and-fill method produced considerably higher risk estimates.
Exposure to new-generation antidepressants is associated with higher suicide risk in adult routine-care patients with depression and other treatment indications. Publication bias and fCOI likely contribute to systematic underestimation of risk in the published literature.
Open Science Framework, https://osf.io/eaqwn/.
对于使用抗抑郁药是否会改变患有抑郁症及其他治疗指征的成年人的自杀风险，目前仍存在争议。
对观察性研究进行系统评价，检索MEDLINE、PsycINFO、Web of Science、PsycARTICLES和SCOPUS数据库，查找病例对照研究和队列研究。我们纳入了关于抑郁症及各种未明确说明的指征（包括超说明书用药）的研究，这些研究报告了使用选择性5-羟色胺再摄取抑制剂（SSRI）及其他新一代抗抑郁药的成年患者相对于未使用者的自杀和/或自杀未遂风险。采用随机效应模型对效应进行荟萃分析，报告相对风险（RR）估计值及95%置信区间（CI）。通过漏斗图不对称性和修剪填充法评估发表偏倚。当第一作者的教授职位由行业资助、他们接受行业报酬或研究由行业资助时，定义存在财务利益冲突（fCOI）。
我们纳入了27项研究，其中19项关于抑郁症，8项关于各种未明确说明的指征（n = 145万受试者）。在抑郁症（RR = 1.03，0.70 - 1.51）和所有指征（RR = 1.19，0.88 - 1.60）中，SSRI与自杀风险（自杀和自杀未遂合并）无明确关联。任何新一代抗抑郁药在抑郁症（RR = 1.29，1.06 - 1.57）和所有指征（RR = 1.45，1.23 - 1.70）中均与较高的自杀风险相关。存在fCOI的研究报告的风险估计值显著低于无fCOI的研究。漏斗图不对称，使用修剪填充法对缺失研究进行插补后得出的风险估计值明显更高。
在患有抑郁症及其他治疗指征的成年常规护理患者中，使用新一代抗抑郁药与较高的自杀风险相关。发表偏倚和fCOI可能导致已发表文献中对风险的系统性低估。
开放科学框架，https://osf.io/eaqwn/ 。
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