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Antidepressiva und Suizidalität

Nutzen-Risiko-Abschätzung

Antidepressants and suicidality

Risk-benefit analysis

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Zusammenfassung

Bei Kindern und Jugendlichen haben Reanalysen plazebokontrollierter Studien Hinweise auf ein erhöhtes Risiko suizidaler Gedanken und suizidaler sowie feindseliger Handlungen nach Behandlung mit SSRI oder anderen neueren Antidepressiva gefunden. Auch wenn es zu keinem Suizid kam, so gewinnen diese Befunde an Gewicht, da mit Ausnahme von Fluoxetin die Evidenzlage bezüglich der antidepressiven Wirksamkeit in dieser Altersgruppe schwach oder fehlend ist. Bei Erwachsenen gibt es keinen Grund, an der suizidpräventiven Wirkung der Antidepressiva zu zweifeln. Ein ausgeprägter suizidinduzierender Effekt der SSRI oder anderer neuerer Antidepressiva kann weitgehend ausgeschlossen werden. Andererseits kann bei vulnerablen Patienten gerade zu Beginn einer Medikation mit Antidepressiva das Suizidrisiko ansteigen. Es gibt keine Belege, dass dieses Risiko für SSRI höher als für andere Antidepressiva oder nichtpharmakologische Behandlungen ist. Die Überdosierungssicherheit ist ein starkes Argument bei ambulanten Patienten mit unklarer Suizidalität, neuere Antidepressiva den trizyklischen Antidepressiva vorzuziehen.

Summary

Reanalyses of placebo-controlled trials reveal an increased risk of suicidal ideations or parasuicidal acts in children and adolescents under treatment with selective serotonin reuptake inhibitors (SSRI) or other antidepressants. Although no completed suicide was shown, these findings are the more important because, with the exception of fluoxetine, an evidence base for the efficacy of antidepressants is weak or lacking in this age group. For adults, there is no reason to doubt that antidepressants help to reduce suicides by shortening depressive episodes and preventing recurrence. A general and pronounced suicide-inducing effect of SSRI or other antidepressants can largely be excluded. On the other hand, in some vulnerable patients the risk of suicidal acts can increase, especially during the first days of antidepressant treatment. There is no evidence that this risk is higher with SSRI than with other antidepressants or nonpharmacological treatments. Safety in case of overdose is a strong argument favouring newer antidepressants over tri- and tetracyclic antidepressants in outpatients with unclear suicidality. The current widespread public discussions concering the risks of antidepressants is a risk in itself because confidence in treatment, compliance, and help seeking behaviour may get influenced negatively.

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  1. Abteilung für Klinische Neurophysiologie, Psychiatrische Klinik der Ludwig-Maximilians-Universität, Nussbaumstraße 7, 80336, München

    U. Hegerl

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  1. U. Hegerl
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Hegerl, U. Antidepressiva und Suizidalität. Nervenarzt 78, 7–14 (2007). https://doi.org/10.1007/s00115-006-2109-8

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