Antidepressants and suicide risk in the United States, 1985-1999.
BACKGROUND
The role of antidepressants in suicide prevention is a major public health question. An association was hypothesized between the increase in the use of non-tricyclic antidepressant medications in the United States and the decline in the suicide rate during the years 1985-1999.


METHODS
The relationships between the suicide, antidepressant prescription, unemployment, and alcoholic beverage consumption rates were studied using generalized linear models. Suicide rates by antidepressant overdose were compared in selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs).


RESULTS
From 1985 to 1999, the suicide rate fell 13.5%, with a greater decline among women, and antidepressant prescription rates increased over 4-fold, with the increase mostly due to SSRIs. Prescription rates for SSRIs and other second-generation antidepressants were both inversely associated with suicide rates (p = .03 and p = .02, respectively). In a multivariable analysis adjusting for unemployment and alcoholic beverage consumption rates, SSRI antidepressant prescription rates remained inversely associated with the national suicide rate (p = .03). Females received twice as many antidepressant prescriptions compared with males. The commonest prescription indication was mood disorders, the condition most often associated with suicide. SSRIs were associated with a lower risk of suicide by antidepressant overdose compared with TCAs.


CONCLUSIONS
The decline in the national suicide rate (1985-1999) appears to be associated with greater use of non-tricyclic antidepressants. Treatment of a greater proportion of mood disorders with SSRIs and other second-generation non-tricyclic antidepressants may further reduce the suicide rate. Controlled studies of the antisuicidal properties of antidepressants are needed in high-risk depressed patient populations.
Grunebaum
Michael F
MF
Department of Neuroscience, New York State Psychiatric Institute, New York, NY 10032, USA. mfg14@Columbia.edu
Ellis
Steven P
SP
Li
Shuhua
S
Oquendo
Maria A
MA
Mann
J John
JJ
D000428:Alcohol Drinking / Q000453:epidemiology; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death / Q000639:trends; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000639:trends; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects; D013405:Suicide / Q000706:statistics & numerical data / Q000639:trends*; D014478:Unemployment / Q000706:statistics & numerical data / Q000639:trends; D014481:United States / Q000453:epidemiology; D000092864:Suicide Prevention
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors