Serious suicidal behaviour is nominally more frequent on antidepressants in posted adult trials, but not after the registered correction

Whether antidepressants raise suicidal behaviour in adults is disputed: the FDA's pooled trials showed no increase past young adulthood, while re-analyses of FDA data on newer drugs found more suicide attempts. We tested this in independent data, the serious adverse events that placebo-controlled trials posted to ClinicalTrials.gov, under a registered plan with trials and terms coded blind to the results. In 306 adult trials, serious suicidal behaviour affected 46 participants on antidepressants and 19 on placebo (risk ratio 1.86, confidence interval 1.06 to 3.27). Neither this nor any serious suicidality (1.48) survives the registered correction for two endpoints, and both shrink under random effects. In pediatric trials, serious suicidality was higher on antidepressants (). These data lean toward more suicidal behaviour in adults, as the re-analyses found, but do not establish it.