Eight studies (n=over 200,000) were included: six cohort and two case control designs.
Among adolescents, exposure to SSRIs significantly increased the risk of completed or attempted suicide (OR 1.92, 95%CI 1.51 to 2.44). SSRI exposure in adults significantly decreased the risk of completed or attempted suicide (OR 0.57, 95% CI 0.47 to 0.70). Among those aged 65 years or older exposure to SSRIs had a significantly protective effect against risk of completed or attempted suicide (OR 0.46, 95% CI 0.27 to 0.79).
Meta-regression using age as moderator and risk of completed or attempted suicide as the dependent variable suggested a promoting effect of SSRI exposure on risk of suicide among adolescents and a protective effect among adults and the elderly.
Two studies reported data on the association of suicide risk with particular antidepressant agents. No specific associations were found among adults. Exposure to paroxetine and venlafaxine were significantly associated with increased risk among adolescents.
There was no significant statistical heterogeneity. No statistically significant asymmetry was found in the funnel plot. However, visual inspection suggested there may have been a lack of small studies that failed to show an excess risk associated with SSRI exposure.
Sensitivity analyses did not change any findings. Elimination of studies from the analysis had little or no effect on the results.