Anti-depressants and Suicide

Abstract

Does drug treatment for depression with selective serotonin reuptake inhibitors (SSRIs) increase or decrease the risk of completed suicide? The question is important in part because of recent government warnings that question the safety of SSRIs, one of the most widely prescribed medications in the world. While there are plausible clinical and behavioral arguments that SSRIs could have either positive or negative effects on suicide, randomized clinical trials have not been very informative because of small samples and other problems. In this paper we use data from 26 countries for up to 25 years to estimate the effect of SSRI sales on suicide mortality using just the variation in SSRI sales that can be explained by cross-country variation in the growth of drug sales more generally. We find that an increase in SSRI sales of 1 pill per capita (about a 12 percent increase over 2000 sales levels) is associated with a decline in suicide mortality of around 5 percent. These estimates imply a cost per statistical life far below most other government interventions to improve health outcomes.

Antidepressants and age: A new form of evidence for U-shaped well-being through life

“…Two exceptions are interesting papers by Kuhn, Lalive and Zweimuller (2009) and Ludwig, Marcotte and Norberg (2009). The first of these shows that job loss caused by plant closure leads to greater antidepressant consumption; the second argues that an increase in sales of one particular antidepressant --selective serotonin reuptake inhibitors (SSRIs) --by 1 pill per capita produces a large reduction (of 5%) in a country's suicide rate.…”

A study of the safety and harms of antidepressant drugs for older people: a cohort study using a large primary care database

“…A number of ecological studies have shown that the suicide rate has decreased as prescribing rates for SSRI antidepressant drugs have increased, but they do not fully account for the decline that started before SSRI antidepressant drugs were introduced. [99][100][101][102][103][104][105] There are mixed results concerning whether use of tricyclic antidepressant drugs has changed suicide rate with claims both that they have increased 102 and decreased rates. [106][107][108] Most studies claim that the largest effects are in the elderly, but absolute risk reductions in suicide with antidepressant drugs in the elderly are low, 109 perhaps contributing to only 10% of the decline in elderly suicides because of underprescribing of effective doses of antidepressant drugs.…”

Suicidal Depressed Patients Respond Less Well to Antidepressants in the Short Term

“…[9] Most epidemiological research also favors the use of antidepressants to reduce suicide risk. [1,10,11] The robust increase in antidepressant prescriptions since the 1990s has been accompanied by fewer suicides in many countries, with some exceptions. [12] Inversely, in several countries a reduction in the rates of antidepressant prescriptions with a consequent increase in the suicide rates have been reported after the warnings, [13] but this issue is still unresolved since there is conflicting evidence about observational studies.…”