Antidepressants and suicidality-controversies and possible mechanisms

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© 2019 Elsevier Inc. All rights reserved. Shortly after fluoxetine, the first SSRI (selective serotonin reuptake inhibitor), entered the marketplace in the late 1980s, it was suggested that this medication could induce suicidal urges in some vulnerable patients. Early epidemiological studies and meta-analyses, however, cast doubt on the link, and the possibility of a causal connection was largely dismissed by the medical community for over a decade. Despite accumulating evidence, which would ultimately result in the placement of a class-wide black box warning for suicidal thoughts and behaviors, the issue remains controversial to this day. Here, we review the history of the discovery of antidepressant-induced suicidal ideation and behavior, highlight the strengths and limitations of the evidence investigating the phenomenon, explore hypothetical mechanisms of action and discuss future directions.

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Neurobiology of Depression: Road to Novel Therapeutics

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