Factors general to changing health care and expectations and others specific to mental health would appear to have led to the increase in rates of admissions observed in the modern period.

Five different mechanisms have been proposed whereby antidepressant treatment might lead to suicide: first by simply ameliorating depressions more rapidly; second by an action intrinsic to the specific antidepressant effects; third by toxicity in overdose; fourth by side-effects of specific antidepressants; and finally by virtue of treatment inefficacy. Evidence from randomized control trials (RCT), controlled case studies and epidemiological studies on this question is reviewed and it is concluded that antidepressants can be implicated in some cases of suicide during treatment. Modifications of clinical trial methods and pharmacogenetic studies would yield a richer data set to explore this issue further.