Suicide and antidepressants.

Depression is associated with a risk of suicide 13 to 30 times greater than in the general population, and antidepressants are among the drugs most frequently implicated in fatal overdose, resulting in a dilemma for the clinician. Suicidal thoughts are a core symptom of depression, and there is evidence that the selective serotonin (5-hydroxytryptamine) reuptake inhibitors (SSRIs), including fluvoxamine, are of particular benefit in reducing their occurrence. Data from controlled studies indicate that the SSRIs do not exacerbate suicidal ideation; on the contrary, SSRIs protect against the emergence of suicidal thoughts, which reflect the natural history of the disease. The SSRIs also appear to be particularly effective in patients who are highly suicidal at treatment initiation, and to be more effective than the tricyclic antidepressants in treating severe depression and improving anxiety symptoms associated with depression. Thus, fluvoxamine, in common with other SSRIs, is of particular benefit in treating depression in patients with prominent suicidal thoughts or who are at increased risk of suicide.