Abstract
It is important to thank Dr Iltis and collaborators for tackling, in their recent article,1 a crucial issue: the almost systematic exclusion of suicidal patients from clinical trials on antidepressants. The exclusion of these individuals is particularly critical given that suicidal behavior is a leading cause of death (about 800,000 deaths by suicide per year worldwide) with very few specific treatments.Until recently, suicidal patients were forgotten in research. Moreover, for a long time, suicidal behavior was considered just a symptom of another psychiatric pathology (mainly depression) and not a specific pathology.3 On the basis of the hypothesis that suicide occurs more frequently in patients with depression, suicidal patients are mostly treated with antidepressants. However, antidepressants were neither developed for nor tested in this specific population. As noted by the authors “The exclusion of persons with suicidality from antidepressant trials is common, creating uncertainty about medication safety and efficacy in parts of the target population.”1(p1) In fact, antidepressant treatments seem to be less efficient in suicidal patients, as highlighted by recent studies showing that these patients respond less well to antidepressant treatment and are less likely to achieve remission.