Research reportAntidepressants and suicide mortality
Introduction
Adequate treatment with antidepressants is often useful in the treatment of moderately and severely depressed patients (Paykel and Priest, 1992). Depressive disorders have been found to be significant risk factors for suicide (Barraclough et al., 1974, Rich et al., 1986, Henriksson et al., 1993). Many recent studies, however, have revealed unidentification and undertreatment of depression among suicide victims (Mendelson and Rich, 1993, Henry, 1994, Isometsä et al., 1994a, Marzuk et al., 1995), and in suicide prevention, therapeutic failure rather than toxicity of antidepressants have been emphasized (Isacsson et al., 1994, Montgomery and Kasper, 1995). Therefore, much attention has been paid to the recognition of depressive disorders and the education of general practitioners, who have a great responsibility for identifying suicide risk, and who also prescribe the majority of antidepressants (Paykel and Priest, 1992, Isometsä et al., 1994b, Donoghue and Tylee, 1996, Rutz et al., 1997).
During the last ten years, several new antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and a selective monoamine oxidase inhibitor, moclobemide, has been introduced in Europe. While one of the major problems with tricyclic antidepressants is their toxicity in overdose (Cassidy and Henry, 1987, Vuori et al., 1989, Kapur et al., 1992), the new antidepressants have been claimed to be as effective as tricyclics (Young et al., 1987, Song et al., 1993, Anderson and Tomenson, 1994, Paykel, 1995) but better tolerated (Anderson and Tomenson, 1995) and less toxic (Freemantle et al., 1994, Henry et al., 1995).
The aim of the present study is to analyse suicide mortality by various methods with a focus on suicides by intake of antidepressants in a period when the use of these drugs more than doubled. Antidepressants are compared by assessing fatality toxicity indices for various antidepressants.
Section snippets
Suicide mortality
The basic data were obtained from the Finnish official statistics on mortality between 1990 and 1995 (Central Statistical Office of Finland, 1991–1996). Suicides were analysed by various methods of suicide (E950-E959) according to the 9th revision of the International Classification of Diseases (WHO, 1977). Suicides by intake of antidepressants were listed separately. Suicide rates were calculated per 100 000 population.
Comparison of various antidepressants
To compare fatality risks of various antidepressants all deaths from drug
Suicide rates by various methods
The total suicide mortality decreased significantly over the study period (Table 2). Suicide rate by poisoning including that by antidepressants, was the only method, which showed an upward trend. This effect was compensated by declined suicide rates by other methods, especially by significantly reduced rates by hanging and carbonmonoxide poisoning.
Suicides by antidepressants among all suicides
Among all suicides over the study period (n=8628), 6.3% were committed by use of antidepressants, with an increasing trend from 5.6% (CI 95%
Antidepressants and suicide rate
In the present study, the expanded use of antidepressants coincided with an increased number of deaths and an upward trend in the suicide rate by these drugs. The increased number of suicides by antidepressants involved mainly tricyclics rather than SSRIs or moclobemide, which showed the largest increase in consumption. Thus, it seems that the possible benefit of the increased use of new antidepressants does not result in a reduced number of suicides by tricyclics, not even by any
Conclusion
In the present study, the expanded use of antidepressants was accompanied by an increase in the number of deaths caused by these drugs, but however, it also coincided with the significantly reduced total suicide mortality. The declined suicide rates by hanging and carbomonoxide poisoning, in particular, compensated the increased figures of suicides by use of drugs including antidepressants. According to fatal outcomes in relation to consumption, the present study suggests substantial
Acknowledgements
This study was supported by Paulo Foundation, Finland.
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