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Independents' Day

CBT: I'll stick to the evidence, thanks

From Dr C Goldsmith


Dr Chris Manning continues to concern me with his 'CBT is not the only fruit' argument (Letters, 1 June).

Last week he attempted to play down the evidence that SSRIs may increase the risk of suicide by asking 'how is it that in nearly every country where SSRI prescribing has increased there has actually been an overall decrease in suicide rate?'.

Now call me a stickler for rational analysis, but I hardly think this argument would stand up to scientific rigour. Suicide rates in these countries could be coming down for many other reasons, such as improving socioeconomic factors.

The key is to formulate an opinion based on firm evidence rather than


New research on this matter is protean and needs to be evaluated carefully. Indeed, just this month a paper in the American Journal of Psychiatry has suggested a causal link between SSRIs and suicide in the first month of use in an analysis of 1,329 suicides, with a five-fold higher risk than other antidepressants in the elderly1.

I am pleased that Chris benefits from SSRIs for his mental and cardiac health, but this member of the 'pro-CBT battalion' would rather give a treatment without side-effects a whirl first.

1 The risk of suicide with selective serotonin reuptake inhibitors in the elderly.

Juurlink DN et al. Am J Psychiatry.

2006 163(5):813-21

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