The association between suicidality and treatment with Selective Serotonin Reuptake Inhibitors in older people with major depression: a systematic review.

Abstract

Review question/objective The objective of this systematic review is to synthesise the best available evidence on the association between treatment with selective serotonin reuptake inhibitors (SSRI) and suicidality/suicide in older people over the age of 60 years who suffer from major depression. More specifically, the review question will be: Does treatment with SSRIs increase the risk of suicide in older people over the age of 60 years who suffer from major depression? Inclusion criteria Types of participants This review will consider older patients aged over 60 years, regardless of gender, sex or race who fulfilled the DSM IV or equivalent diagnostic criteria for Major Depressive Disorder without psychotic features. The review will consider both community and hospitalised older patients with stable medical co morbidities. Types of intervention(s)/phenomena of interest The focus of this review is on the association between treatment with SSRIs and the harmful outcome of suicidality/suicide. The review will consider treatments using any SSRI medication which includes fluoxetine, sertraline, paroxetine, citalopram, escitalopram and fluvoxamine given orally with clinically effective dose recommended by the manufacturer for older people for a minimum duration of treatment of four weeks. Types of outcomes The main outcomes of interest are suicidal ideation, number of suicide attempts and mortality due to suicide. For this systematic review, the term 'suicide attempt' refers to potentially self-injurious behaviour with a nonfatal outcome, for which there is evidence (either implicit or explicit) that the person intended at some (nonzero) level to kill himself/herself.28 Suicide ideation may be measured by Scale for Suicidal Ideation, Hamilton Rating Scale for Depression (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck's Depression Inventory (BDI). HAM-D item number 3 suicidal idea scale ranged from 0 to 4; BDI item number 9 suicidal thought scale ranged from 0-3; and MADRS item number 10 suicidal thought scale ranged from 0-6. Types of studies This review will consider both experimental and epidemiological study designs including randomised controlled trials, non-randomised controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case control studies.