Drop
of suicide rates with increased use of SSRIs and
new non-SSRIs
Approximately
1 million suicides occur annually worldwide.
Mood disorders are the most common psychiatric
illnesses associated with suicide, but they are
mostly untreated at the time of death. However
the relationship between antidepressant use and
the rate of suicide is not clearly known. The
association between the volume of pharmacy
prescriptions of antidepressants and suicide
rate adjusted for sex, race, age, and income,
has thus been analyzed at the county level
across the United States.
Suicide rates for 1996 to 1998 for each US
county were obtained from analysis of National
Vital Statistics from the Centers for Disease
Control and Prevention. Suicide rate data were
classified by sex, race, and age. Antidepressant
medication rate data were expressed as the
number of pills prescribed per county from 1996
to 1998, for 3 antidepressant subclasses,
tricyclic antidepressants (TCAs), selective
serotonin reuptake inhibitors (SSRIs), and other
non-SSRI antidepressants. The main outcome was
the suicide rate in each county expressed as the
number of suicides for a given population
size.
After adjustment for age, sex, race, income, and
county-to-county variability in suicide rates,
there was no statistically significant overall
relationship between the total number of
prescribed antidepressant drugs and suicide
rate. However using a model to determine whether
antidepressant class-specific associations
exist, it was found that increases in prescribed
SSRIs and other new-generation non-SSRIs, such
as nefazodone, mirtazapine, bupropion, and
venlafaxine, were associated with decreases in
the suicide rate. In contrast, prescriptions for
TCAs were associated with increases in the
suicide rate. In rural areas, higher suicide
rates were linked to fewer antidepressant
prescriptions, lower income, and relatively more
prescriptions for TCAs.
These data indicate that in counties where
access to quality mental health care is limited,
depression is under-detected and under-treated,
thus leading to increased suicide rates. These
counties are characterised by a high proportion
of prescriptions of TCAs. On the contrary,
prescriptions for SSRIs and other new-generation
non-SSRIs are associated with lower suicide
rates, showing antidepressant efficacy,
compliance, and a better quality of mental
health care. Gibbons
RD, Hur K, Bhaumik DK, Mann JJ. The relationship
between antidepressant medication use and rate
of suicide. Arch Gen Psychiatry 2005, 62:
165-172.