BMJ 2003;326:1008 ( 10 May )

Papers

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

Wayne D Hall, professor and director a, Andrea Mant, associate professor b, Philip B Mitchell, professor and head of psychiatry c, Valerie A Rendle, research assistant b, Ian B Hickie, professor of community psychiatry d, Peter McManus, committee secretary e. 

a Office of Public Policy and Ethics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland 4072, Australia, b School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia, c School of Psychiatry, University of New South Wales, Randwick, New South Wales 2031, Australia, d beyondblue: the national depression initiative, Melbourne, Victoria 3122, Australia, e Drug Utilisation Subcommittee, Department of Health and Ageing, Canberra 2601, Australia

Correspondence to: A Mant a.mant@unsw.edu.au


    Abstract

Objective: To examine the association between trends in antidepressant prescribing and suicide rates in Australia for 1991-2000.
Design: Analysis of databases of suicide and rates of antidepressant prescribing according to age and sex.
Setting: Australian Bureau of Statistics data, sales data from the Australian pharmaceutical industry, prescribing data in general practice.
Subjects: Men and women aged 15 years and over in 10 year age groups.
Main outcome measures: Trends in suicide rates and trends in antidepressant prescribing. Association measured by Spearman's rank correlations.
Results: While overall national rates of suicide did not fall significantly, incidence decreased in older men and women and increased in younger adults. In both men (rs=-0.91; P<0.01) and women (rs=-0.76; P<0.05) the higher the exposure to antidepressants the larger the decline in rate of suicide.
Conclusions: Changes in suicide rates and exposure to antidepressants in Australia for 1991-2000 are significantly associated. This effect is most apparent in older age groups, in which rates of suicide decreased substantially in association with exposure to antidepressants. The increase in antidepressant prescribing may be a proxy marker for improved overall management of depression. If so, increased prescribing of selective serotonin reuptake inhibitors in general practice may have produced a quantifiable benefit in population mental health.

What is already known on this topic
There has been a substantial increase in antidepressant prescribing by general practitioners in Australia since the introduction of selective serotoin reuptake inhibitors in the early 1990s

Previous studies have indicated an association between increased antidepressant prescribing and reduced suicide rate

What this study adds
In Australia the rate of suicide fell in older people, the age group most heavily exposed to antidepressants

Most antidepressants are now prescribed by general practitioners

The association may indicate the improved treatment of depression by general practitioners



The first 150 words of the full text of this article appear below.

    Introduction

In many developed countries the number of prescriptions for antidepressants increased steeply during the 1990s, after the introduction of selective serotonin reuptake inhibitors (SSRIs).1-4 In some countries the increased rate of prescribing coincided with fall in the suicide rate.2-4

Research has been carried out to test the hypothesis that increased antidepressant prescribing was partially responsible for this decline. In Sweden between 1991 and 1996 antidepressant prescribing increased steeply after the introduction of the SSRIs in 1990, and the rate of suicides was inversely related to rates of antidepressant prescribing in most age and sex groups.3 In another study in Sweden Carlsten et al examined data for 1977-97 (using official mortality statistics) and data on antidepressant use from surveys of sales to pharmacies.2 They found that suicide rates declined over the whole study period, but the rate of decline accelerated after the SSRIs were introduced in 1990. In Hungary in 1984-98 antidepressant prescribing rose steeply . . . [Full text of this article]
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Rapid Responses:

Read all Rapid Responses

Another plausible alternative explanation
Dan E Bilsker
bmj.com, 10 May 2003 [Full text]
Conflicts of interest
Gurli Bagnall
bmj.com, 10 May 2003 [Full text]
It will be more interesting to include patients who recieve ECT..etc?
AK Al-Sheikhli
bmj.com, 13 May 2003 [Full text]
Antidepressants do not reduce suicide rates
Peter H Ankarberg
bmj.com, 13 May 2003 [Full text]
Decline in older age suicide rate pre-dates 1991
Thomas J Verberne
bmj.com, 14 May 2003 [Full text]
More than antidepressants are needed to avert suicide
Diego De Leo, et al.
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A Patient's View
Simon D Allen
bmj.com, 16 May 2003 [Full text]
Caution in interpretation
Stephen J Senn
bmj.com, 19 May 2003 [Full text]
Misleading analysis
Joanna Moncrieff
bmj.com, 19 May 2003 [Full text]
Decline in older suicides in Australia was much greater before the SSRIs were introduced
Brian M Draper
bmj.com, 21 May 2003 [Full text]
Misleading assessment of the relation between trends in antidepressant prescribing and suicide.
David Gunnell, et al.
bmj.com, 6 Jun 2003 [Full text]
Responses to our critics
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bmj.com, 10 Jun 2003 [Full text]
Re: Responses to our critics
Thomas J P Verberne
bmj.com, 16 Jun 2003 [Full text]
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