A recent study revealed some disturbing information about the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs): their use is modestly associated with violent crime.
The cohort study, published this week in PLOS Medicine, showed that the association was evident in participants aged 15-24, but not significant for individuals aged 25 and older.
A cohort study is an observational study that follows a group of individuals who are identical with the exception of exposure to a specific factor to determine whether exposure to that factor increases the likelihood of a specific outcome. In this case, the researchers investigated the association between violent crime and SSRIs in Sweden.
For this study, Seena Fazel of the University of Oxford and colleagues compared the rate of violent crime while individuals were prescribed SSRIs with the rate of violent crime in the same individuals while not receiving medication, using matched data from the Swedish Prescribed Drug Register and the Swedish national crime register.
During the 4-year study period, about 850,000 individuals (10.8% of the Swedish population) were prescribed SSRIs, and 1% of these individuals were convicted of a violent crime. The result was an overall association between SSRI use and violent convictions. Increased risks were also found in individuals aged 15-24 years for violent arrests, non-violent convictions and arrests, non-fatal accidental injuries, and emergency contacts for alcohol problems.
For adults between the ages of 15 and 24, the risk of being convicted of a violent crime was 43% greater when they were taking an SSRI than when they weren’t.
Among men, taking SSRIs was linked with a 40% increased risk of being convicted of a violent crime; among women, the risk increased by 75%, according to the study.
These findings do not prove that taking SSRIs actually causes an increase in violent crime – other unknown factors may play a role.
However, if these results are confirmed in additional studies, warnings about the increased risk of violent behavior among young people taking SSRIs might be needed. For now, doctors must weigh the SSRI-associated increase in violent crime against SSRI-associated reduction of disability, hospitalization, and suicide.
The authors state:
The lack of a significant association between SSRIs and violent crime among most people taking SSRIs is reassuring; the association between violent crimes and SSRIs among individuals younger than 25 years is worrying.
From a public health perspective, this worsening of overall morbidity and mortality might argue against restrictions on the primary care prescribing of SSRIs as long as potential risks are disclosed.