Suicide prevention and serotonergic drugs.

It is sometimes assumed that all antidepressants have a beneficial effect in reducing suicidal ideation or tendencies but there is evidence to suggest a better effect with some and that others may even provoke suicide attempts. Possible provocation of suicide attempts may be invoked to explain the high rate of attempts reported in a study with maprotiline compared with placebo and the higher rate of deaths from overdose seen with some tricyclic antidepressants. Serotonin reuptake inhibitors have been rather consistently reported to have an advantage in reducing suicidal ideation and have been shown to have a protective effect against the emergence of suicidal thoughts. In a direct test of the effect of serotonin reuptake inhibitors on suicidal behaviour there was no provocation of suicide attempts.