Повышают ли антидепрессанты риск суицида?

The widespread use of antidepressants in various areas of medicine and the long duration of treatment have led to discussions on the relationship between effectiveness and different risks of their prescription. In particular, the extent to which taking antidepressants is associated with an increased risk of suicide is a matter of great attention. The aim of the study was to conduct a non-systematic review and analysis of the literature on the relationship between antidepressant therapy and the risk of suicidal behavior. The results showed that the original studies were conducted using a heterogeneous methodology and were accompanied by contradictory findings. According to one data, the usage of antidepressants increases the risk of suicide at a young age and above 65 years of age. The emergence of suicidal thoughts in adults when prescribing antidepressants is rare and usually tends to progressively weaken during the first 4-6 weeks of treatment. The most severe predictors of suicidal ideation and suicide attempts during antidepressant therapy include such factors as starting therapy with high doses, lack of response to treatment, past suicide attempts, comorbid systemic disease and substance abuse. At the same time, a number of pharmacoepidemiological studies suggest that antidepressant treatment of depression mainly reduces the risk of suicide. In addition, autopsies with toxicological detection of antidepressants have shown that suicides are more often committed by those patients with depression, who are not taking therapy. Suicidality rates may also increase after therapy is prescribed due to the fact that patients may hide their suicidal thoughts before treatment, and doctors often fail to diagnose bipolar affective disorder. There is now a growing body of evidence on the involvement of genetic factors and biological systems in the development of suicide risk. There are data on the role of BDNF, NTRK2, MAPK1, CREB1, CRHR1, TBX19, FKBP5, SKA2, CDH10, CDH12, CDH13, CDH9, DLK1, DLK2, EFEMP1, FOXN3, IL2, LSAMP, NCAM1, NGF, и TBC1D1 genes in suicidal behaviour. According to MRI data, a decrease in brain grey matter in the insular gyrus on both sides, in the right lower frontal gyrus and in other surrounding structures responsible for emotions and self-regulation is observed in persons with suicidal behaviour and self-harm. A number of studies aimed to identify genetic markers of the activation of suicidal behavior when taking antidepressants, and the involvement of genes GDA, CREB1, BDNF, NTRK2, GRIA3, GRIK2, ADRA2A, FKBP5, IL28RA, PAPLN, TMEM138, CTNNA3, RHEB, CYBASC3 and AIMI was revealed. At the same time, there are no reliable biomarkers yet, and the role of antidepressants in increasing suicide risk remains open. The social significance of the problem and the great public response force regulators to make hasty decisions in this case. To more definitely address the impact of antidepressants on the risk of suicide, it is necessary to plan specialized large-scale studies that should take into account a significant number of additional clinical and sociodemographic factors (age of the patient, sex, severity of depression, substance use, the probability of diagnostic error, compliance with the therapy regime), as well as biological and genetic indicators for an objective assessment of the suicidal danger of drugs.