Antidepressants and suicidality: A re-analysis of the re-analysis.
Antidepressants
Meta-analysis
Suicide
Suicide attempts
Suicide risk
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
01 04 2020
01 04 2020
Historique:
received:
04
09
2019
revised:
23
11
2019
accepted:
20
01
2020
pubmed:
15
2
2020
medline:
16
2
2021
entrez:
15
2
2020
Statut:
ppublish
Résumé
A recent study by Hengartner and Plöderl describes a strong increase for suicides (odds ratio (OR) of 2.83, 95% CI=1.13-9.67) and suicide attempts (OR=2.38 95%, CI=1.63-3.61) in antidepressant treated patients as compared to placebo. The authors re-analyzed data presented by Khan et al. who found no drug-placebo differences in suicide and suicide attempt rates. Hengartner and Plöderl base their findings on calculating the OR from a 2×2 table of the sum of the events and the totals of the sample sizes across studies. We here argue that pooling data from all drugs may not be the adequate approach. We applied a meta-analytical approach to account for between-drug variance and conducted several statistical analyses as a sensitivity analysis. We argue that a more suitable approach for finding an overall effect from several observations is a meta-analytical approach namely the Mantel-Haenszel method without continuity correction. Our analysis leads to different conclusions as opposed to Hengartner and Plöderl. With the recommended method we estimate an OR of 1.98, 95% CI 0.71-5.50 for suicides and 1.63 (95%CI=1.09-2.43) for suicide attempts. The conducted analysis was restricted to the data available from the previous studies. Possibly, a more extensive search of the literature would lead to different results. However, we showed that re-analysing the re-analysis with several different approaches underlines the necessity of sensitivity analysis. We could show that, in the case of rare events, the data is very sensitive to different analytical approaches underlining the importance of further investigations.
Sections du résumé
BACKGROUND
A recent study by Hengartner and Plöderl describes a strong increase for suicides (odds ratio (OR) of 2.83, 95% CI=1.13-9.67) and suicide attempts (OR=2.38 95%, CI=1.63-3.61) in antidepressant treated patients as compared to placebo. The authors re-analyzed data presented by Khan et al. who found no drug-placebo differences in suicide and suicide attempt rates. Hengartner and Plöderl base their findings on calculating the OR from a 2×2 table of the sum of the events and the totals of the sample sizes across studies. We here argue that pooling data from all drugs may not be the adequate approach.
METHODS
We applied a meta-analytical approach to account for between-drug variance and conducted several statistical analyses as a sensitivity analysis. We argue that a more suitable approach for finding an overall effect from several observations is a meta-analytical approach namely the Mantel-Haenszel method without continuity correction.
RESULTS
Our analysis leads to different conclusions as opposed to Hengartner and Plöderl. With the recommended method we estimate an OR of 1.98, 95% CI 0.71-5.50 for suicides and 1.63 (95%CI=1.09-2.43) for suicide attempts.
LIMITATIONS
The conducted analysis was restricted to the data available from the previous studies. Possibly, a more extensive search of the literature would lead to different results. However, we showed that re-analysing the re-analysis with several different approaches underlines the necessity of sensitivity analysis.
CONCLUSION
We could show that, in the case of rare events, the data is very sensitive to different analytical approaches underlining the importance of further investigations.
Identifiants
pubmed: 32056952
pii: S0165-0327(19)32395-X
doi: 10.1016/j.jad.2020.01.107
pii:
doi:
Substances chimiques
Antidepressive Agents
0
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
95-99Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Declaration of Competing Interest The authors have no conflicts of interest to declare.