Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant medications first introduced in the United States in the late 1980s, beginning with fluoxetine (Prozac). Since that time, multiple SSRIs have been widely prescribed for depression and related conditions.
An article published in PLoS Medicine (September 2006) examined data from clinical trials to explore potential associations between SSRI use and aggressive or hostile behavior. The analysis focused in part on paroxetine. Across the studies reviewed, 60 of 9,219 patients treated with paroxetine (0.65%) experienced what investigators classified as a “hostile” event, compared with 20 of 6,455 patients (0.31%) receiving placebo. This corresponded to an odds ratio of 2.10 for hostile events among paroxetine-treated participants.
Based on their review, the authors reported that SSRI use may be associated with an increased risk of aggressive or violent behavior in a small subset of patients and emphasized the importance of clinician awareness of this possibility. The authors also noted that such events were uncommon overall.
This publication reflects early efforts to systematically evaluate behavioral adverse effects of SSRIs using clinical trial data. Subsequent research has continued to examine these questions using larger datasets, different methodologies, and expanded post-marketing surveillance.
