Selective serotonin reuptake inhibitors and violence: a review of the available evidence

Objective: To provide a clinically useful analysis of the relationship betw een selective serotonin reuptake inhibitors (SSRIs), in particular fluoxeti ne and violent or suicidal behaviour. Method: All published papers on Medline and other databases linking seroton in. SSRIs and aggression were reviewed. Results: A small proportion of patients treated with SSRIs may become akath isic and others may show increases in anxiety in the initial phase of treat ment, but no increased susceptibility to aggression or suicidality can be c onnected with fluoxetine or any other SSRI. In fact SSRI treatment may redu ce aggression, probably due to positive effects on the serotonergic dysfunc tion that is implicated in aggressive behaviour directed towards oneself or others. Conclusion: In the absence of convincing evidence to link SSRIs causally to violence and suicide, the recent lay media reports are potentially dangero us, unnecessarily increasing the concerns of depressed patients who are pre scribed antidepressants.