1/ UK's Medicines and Healthcare products Regulatory Agency just updated safety measures for antidepressant use. Regarding suicide risk, they rely on a recent systematic review of RCTs. And here is where the problems start. Thread (started today, may get longer over time)

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2/ The review in question by Li et al. looked for all published (!) RCTs which reported results of suicide ideation 2, 8, and 12 weeks. www.sciencedirect.com/science/arti... This resulted an a very small selection of existing antidepressant trials: 7 to 16 trials only!

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3/ Just compare this to the data available to the FDA (Stone et al. 2009, BMJ), with 295 trials and about 27,000 participants! Therefore, the review by Li et al. is a tiny fraction of all available trials. And it gets worse

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4. Look at the results at 2w for paroxetine, fluoxetine, escitalopram, and non-SSRIs. First, these effects are implausibly large. Second, if SSRIs work short-term, why the null-result for the SSRI sertraline (which has the smallest CI). Third, the results are grossly different to the 8-week result.

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5. Drug-placebo differences slightly increase over the first weeks, and there is no reason to assume that this is very different for suicide ideation as one symptom of depression. Now look at escitalopram at 2w. This effect on a small single RCT from China. Link to study does not work.

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