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To the Editor: The study by Dr Jick and colleagues¹ found that "the risk of suicidal behavior is increased in the first month after starting antidepressants, especially during the first 1 to 9 days." However, the larger current debate concerning the risk of suicidal behavior associated with antidepressant treatment, which is usually framed as a newly discovered phenomenon, appears to ignore the history of medical literature.

Long before any selective serotonin reuptake inhibitor had been introduced, there was a strong clinical warning concerning the risk of suicide during treatment with antidepressants. In fact this warning had been clearly spelled out 36 years ago in the Noyes’ Modern Clinical Psychiatric Textbook.² In the section on affective reaction, depressive phase (the first edition of the Diagnostic and Statistical Manual of Mental Disorders terminology), it is stated that "The usual opinion is that [the patient] should remain in an institution with its . . . [Full Text of this Article]

Iradj Maany, MD
Maany_I@mail.trc.upenn.edu
University of Pennsylvania
Philadelphia VA Medical Center
Philadelphia

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