Serotonin selective reuptake inhibitors and suicide risk in a Portuguese adolescent sample




Background: The adolescent population is at high risk for depressive disorders, and suicide is a leading cause of death in this age group worldwide. Selective serotonin reuptake inhibitors (SSRIs) remain the only approved pharmacological approach, despite concerns about suicidality.
Objectives: This study aimed to understand the relationship between antidepressant use and suicidality in an adolescent population from an Adolescent Psychiatric unit in Lisbon, Portugal.
Methods: A total of 296 medical reports of adolescent patients with depressive symptoms in psychiatric follow-up at the considered unit were reviewed. Two demographically and clinically similar samples were obtained, one exposed to SSRI treatment and one control group.
Results: A risk of suicide attempt of 0.006 was found in the group exposed to SSRIs versus 0.025 in the control group, corresponding to a relative risk of suicidality of 0.248. This difference did not reach statistical significance, despite a Bayes factor of 4.57 and a Pearson’s r of -0.078.
Conclusions: The study results suggest that SSRIs do not increase the risk of suicide attempt in adolescents with depressive symptoms.


Download data is not yet available.


Adolescent health. Accessed July 11, 2022.

Suicide worldwide in 2019. Accessed July 16, 2022.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602. doi:

Cousins L, Goodyer IM. Antidepressants and the adolescent brain. J Psychopharmacol. 2015;29(5):545-555. doi:

Fazel S, Runeson B. Suicide. Ropper AH, ed. 2020;382(3):266-74. doi:10.1056/NEJMRA1902944.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. (American Psychiatric Association, ed.).; 2013.

ICD-11 for Mortality and Morbidity Statistics. Accessed July 11, 2022.

Recommendations | Depression in children and young people: identification and management | Guidance | NICE. Accessed July 11, 2022.

CMS. Antidepressant Medications: U.S. Food and Drug Administration-Approved Indications and Dosages for Use in Pediatric Patients. Accessed July 11, 2022.

Lagerberg T, Fazel S, Sjölander A, Hellner C, Lichtenstein P, Chang Z. Selective serotonin reuptake inhibitors and suicidal behaviour: a population-based cohort study. Neuropsychopharmacol 2021 474. 2021;47(4):817-23. doi:

Sørensen JØ, Rasmussen A, Roesbjerg T, Verhulst FC, Pagsberg AK. Suicidality and self-injury with selective serotonin reuptake inhibitors in youth: Occurrence, predictors and timing. Acta Psychiatr Scand. 2022;145(2):209-22. doi:

Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry. 1990;147(2):207-10. doi:

Friedman RA. Antidepressants’ Black-Box Warning — 10 Years Later. N Engl J Med. 2014;371(18):1666-8. doi:

Portal do INE. Accessed July 16, 2022.

– Sem Mais Tempo a Perder: Saúde Mental em Portugal – Um desafio para a próxima década - CNS. Accessed July 16, 2022.

Repositório Institucional da Universidade Fernando Pessoa: Análise da evolução do consumo de ansiolíticos e antidepressivos em Portugal continental entre 2010 e 2020. Accessed July 16, 2022.

Beard E, Dienes Z, Muirhead C, West R. Using Bayes factors for testing hypotheses about intervention effectiveness in addictions research. Addiction. 2016;111(12):2230. doi:10.1111/ADD.13501.

Zygo M, Pawłowska B, Potembska E, Dreher P, Kapka-Skrzypczak L. Prevalence and selected risk factors of suicidal ideation, suicidal tendencies and suicide attempts in young people aged 13-19 years. Ann Agric Environ Med. 2019;26(2):329-36. doi:10.26444/AAEM/93817.




How to Cite

Duarte N, Amaral S, Abrantes M. Serotonin selective reuptake inhibitors and suicide risk in a Portuguese adolescent sample. REVNEC [Internet]. 2023Nov.16 [cited 2023Dec.10];32(3):189-94. Available from:



Original Articles