BMJ  2003;327:288-289 (2 August), doi:10.1136/bmj.327.7409.288-c

Letter

Antidepressant prescribing and suicide

Antidepressants do not reduce suicide rates

EDITOR—Hall et al show that the biggest increase in the use of antidepressants in 1990-2000 has been in the 15-44 age group.¹ Simultaneously the rate of suicide for this age span has increased in Australia. For men aged 25-34 the use of antidepressants has increased more than six times during the period and the suicide rate has increased by almost 17%.

By using this correlation in time in the same way that Hall et al use the total correlation for all ages it could be argued that antidepressants increase the risk of suicide for people younger than 45 and particularly for men aged 25-34. Neither this conclusion nor that of Hall et al is scientifically valid. To make valid conclusions we need controlled studies.

Hall et al say that there is little direct evidence that antidepressants reduce the suicide rate because even large clinical trials have limited power to detect a reduction. They do not mention that three large meta-analyses on antidepressants and suicide have been published since 2000.^2-4

Together these include over 60 000 depressed patients in randomised clinical trials comparing antidepressants with placebo. Most trials were short term, but several long term trials were also included, with a total of 1949 patients. The results of all meta-analyses, both for short term and long term treatment, were that suicide was slightly more common among patients taking antidepressants compared with patients taking placebo.

Hall et al do not show that antidepressants reduce the rate of suicide. At the same time placebo controlled randomised clinical trials show that the rate of suicide is higher with antidepressants than it is with placebo. The only reasonable conclusion is that anti-depressants do not reduce the rate of suicide. There may be a slight increase in suicide rates for patients treated with antidepressants, although further studies are needed to make any firm conclusions.

Samtalscentrum Unga Vuxna, Repslagargatan 5A, S-611 30 Nyköping, Sweden peter.ankarberg{at}spray.se

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Competing interests: None declared.

References

1. Hall DW, Mant A, Mitchell PB, Rendle VA, Hickie IB, McManus P. Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis. BMJ 2003;326: 1008-12. (10 May.)[Free Full Text]
2. Khan A, Khan S, Kolts R, Brown WA. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry 2003;160: 790-2.[Abstract/Free Full Text]
3. Khan A, Warner HA, Brown WA. Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: An analysis of the Food and Drug Administration database. Arch Gen Psychiatry 2000;57: 311-7.[Abstract/Free Full Text]
4. Storosum JG, van Zwieten BJ, van den Brink W, Gersons B, Broekmans AW. Suicide risk in placebo-controlled studies of major depression. Am J Psychiatry 2001;158: 1271-5.[Abstract/Free Full Text]

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Relevant Article

Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis

Wayne D Hall, Andrea Mant, Philip B Mitchell, Valerie A Rendle, Ian B Hickie, and Peter McManus
BMJ 2003 326: 1008. [Full Text] [PDF]