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No. 3 (2024)

GENERAL THERAPY QUESTIONS AND REVIEWS

Suicide and Selfharm Resulting from Antidepressants: Facts and Interpretations

Published 2024-09-30

  • V.D. Mendelevich
    • ,
  • P.V. Koroleva
    • ,
  • M.K. Nesterina

V.D. Mendelevich
Kazan State Medical University, Kazan, the Republic of Tatarstan

P.V. Koroleva
Kazan State Medical University

M.K. Nesterina
Kazan State Medical University, Kazan, the Republic of Tatarstan

Abstract

The article analyzes the relationship between the use of antidepressants and an increase of suicidal risk. The heated scientific debate that has unfolded in the pages of journals is highlighted, and the arguments of both proponents and opponents are presented. It is concluded that the problem is not the rejection of the existence of such a connection, but in the distortion of its interpretation. The following questions are raised: 1) if antidepressants increase the risk of suicide before they begin to act, then why its suicidal effect is associated with their use? 2) why does an increase in suicidal risk occur not only after starting selective serotonin reuptake inhibitors (SSRIs), but also, for example, with tricyclic antidepressants, which have almost immediate effect? 3) why is there little evidence in the scientific literature that suicidal risk increases when SSRIs are used not to treat depression, but, for example, to treat anxiety or obsessive-compulsive disorder? 4) can any chemical substances (pharmacological drugs) themselves affect human meanings — lead to the emergence of ideas about unwillingness to live or, conversely, stimulate a person to live? 5) why are both suicidal and self-harm behavior, based on fundamentally different mechanisms of psychogenesis, included in the same list of negative consequences of SSRI use? It is concluded that the analysis of association found between the use of antidepressants (primarily SSRIs) and an increased suicidal risk should not be interpreted as cause-and-effect, mainly because suicide as a social and personal phenomenon cannot be derived from biological (pharmacological) grounds. It should be noted that the appearance of suicidal thoughts and then actions can be facilitated by any emotional state in which a person is not able to think critically and fully understand the nature of their actions. However, even if the loss of meaning in life is provoked by neurobiological factors or psychopharmacological influences, suicidal behavior should be considered as a volitional, meaningful act. The meaning and content of thoughts cannot be determined by the brain activity, and no medication (for example, antidepressants) can cause suicidal ideas and intentions.

Keywords

suicide, self-harm, antidepressants, suicidal risk, selective serotonin reuptake inhibitors

PDF (Русский)

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