The small number of suicide attempts across the trials make the results of the meta-analysis difficult for physicians and policymakers to use, write Ross J. Baldessarini, M.D., of McLean Hospital, Belmont, Mass., and colleagues in an accompanying editorial.

Measuring suicidality rather than suicides or suicide attempts may not paint an accurate picture of the risk associated with the drugs, they continue. “Only a small fraction of patients with suicidal thoughts attempt suicide, few attempts prove to be fatal and risk factors for suicide attempts (e.g., younger, female) and completions (e.g., older, male) differ markedly,” they write. “Moreover, suicidal ideation, but usually not suicidal behavior, has been reduced with antidepressant drug treatment.”

“When adverse responses do occur, they are often detectable with close clinical follow-up and psychological support, especially early in treatment, as recommended in recent FDA clinical advisories,” they conclude. “Moreover, they may be reversed with appropriately modified treatment.”

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