The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study

doi:10.1136/bmj.39462.375613.BE

BMJ, doi: 10.1136/bmj.39462.375613.BE, (Published 14 February 2008)

Research

The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom: ecological study

Benedict W Wheeler, research fellow¹, David Gunnell, professor of epidemiology¹, Chris Metcalfe, lecturer in medical statistics¹, Peter Stephens, vice president, public health affairs², Richard M Martin, reader in clinical epidemiology¹

¹ Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ² IMS Health, London

Correspondence to: B W Wheeler ben.wheeler{at}bristol.ac.uk

Objective To investigate the population impact on the incidenceof suicide and non-fatal self harm of regulatory action in 2003to restrict the use of selective serotonin reuptake inhibitors(SSRIs) in under 18s.

Design Ecological time series study.

Setting United Kingdom.

Populations Young people in the UK aged 12-19 years (prescribingtrends), in England and Wales aged 12-17 years (mortality),and in England aged 12-17 years (hospital admissions).

Main outcome measures Deaths from suicide and hospital admissionsfor self harm.

Results Antidepressant prescribing doubled between 1999 and2003 but fell to the 1999 level between 2004 and 2005. Theselarge changes in prescribing did not seem to be associated withtemporal trends in suicide or self harm. In the years 1993 to2005 the annual percentage reduction for suicide among 12-17year olds was –3.9% (95% confidence interval –6.2%to –1.5%) in males and –3.0% (–6.6% to 0.6%)in females, with no indication of a substantial change in thisrate of decrease during that period. Similarly, hospital admissionrates for self harm in the years 1999 to 2005 indicated an annualpercentage increase for males of 1.1% (–0.5% to 2.7%)and for females of 5.7% (3.6% to 7.8%), again with no statisticalevidence of a change in rate after the regulatory action.

Conclusions The noticeable reduction in prescribing of antidepressantssince regulatory action in 2003 to restrict the use of SSRIsin under 18s does not seem to have been associated with changesin suicidal behaviour in young people. Specifically, these datafor England do not indicate that reductions in antidepressantuse have led to an increase in suicidal behaviour.

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