Selective serotonin reuptake inhibitors and suicide: is the evidence, as with beauty, in the eye of the beholder?

The recent debate started by David Healy [1] on the pages of this journal and further fueled by letters published in this issue [2–4] sparks again the decade-old debate ‘as to whether selective serotonin reuptake inhibitors (SSRIs) can trigger suicidality in vulnerable individuals’ [1]. The article by Healy [1] is carefully and elegantly written, and avoids definite statements, however the effect is, like in any good propaganda, that the reader may conclude that SSRIs at least increase the risk of suicide, if they do not outright cause it. The question for a careful and analyzing reader remains: Is that so? Is the evidence there? Giovanni Fava [5] on the pages of this journal quotes Chomsky’s [6] work on propaganda and its mechanisms – namely filtering information (selective perception), engineering opinion, using the public relations industry and marginalizing dissident cultures. Sifting through Healy’s [1] article and the literature on SSRIs and suicide, I started to wonder how many of the described mechanisms of propaganda or at least some of its elements mentioned by Fava [5] are part of this debate. Many perceive propaganda as something coming to us from big government, ‘big brother’, special interest groups or big corporations. However, propaganda does not have a single set of parents, or a specific address. There is no doubt that the field of medicine has been flooded by propaganda from the pharmaceutical industry. The pharmaceutical industry has certainly been filtering the information coming to us, engineering opinions, using public relations industry and marginalizing the few remaining dissidents. We have become oblivious, numb and superficial in critically evaluating and incorporating scientific information – how many of us go beyond reading the abstract of most, if not all, scientific articles? During the few and short lucid moments of attempting to reconcile our greed with our conscience, we may feel guilty and cheering the dissidents. We may feel especially strong in our cheering if these ‘dissidents’ are such skillful writers as David Healy. I have to admit that I loved his statement that, ‘The psychobabble of yesteryear is being rapidly replaced by a new biobabble’ [7]. How succinct and how true! Nevertheless, while reading the article on SSRIs and suicide [1], I begin to wonder whether propaganda in this, like in many previous cases, could also originate on the other side of the debate, i.e. among the ‘dissidents’. It is important to realize the amount and pressure of propaganda in any debate and especially in a ‘scientific’ one, on both sides of the ‘aisle’. As the readers of the journal are mostly familiar with Healy’s [1] article and the ensuing correspondence [2–4], I decided to ‘analyze’ a bit his article and letter with respect to their arguments, interpretation of data and writing style regarding the possible stylization of scientific argument into propaganda. I will also discuss a few new articles that appeared in press during this debate. On purpose, I tried to avoid analyzing and discussing the entire literature on SSRIs and suicide. That