title: Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study.
abstract: Research concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants.
  
  
  
  Data were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980-1994 and 1995-2009.
  
  
  
  An inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994.
  
  
  
  Suicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.
authors.affiliation: CEDOC, Departamento de Saúde Mental, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal ; Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gusmão
authors.forename: Sónia
authors.initials: S
authors.lastname: Quintão
authors.forename: David
authors.initials: D
authors.lastname: McDaid
authors.forename: Ella
authors.initials: E
authors.lastname: Arensman
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Audenhove
authors.forename: Claire
authors.initials: C
authors.lastname: Coffey
authors.forename: Airi
authors.initials: A
authors.lastname: Värnik
authors.forename: Peeter
authors.initials: P
authors.lastname: Värnik
authors.forename: James
authors.initials: J
authors.lastname: Coyne
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D017723:Drug Utilization Review; D005060:Europe / Q000453:epidemiology; D006801:Humans; D013405:Suicide / Q000706:statistics & numerical data*
chemical_list: D000928:Antidepressive Agents