Suicide and the use of antidepressants Drug treatment of depression is inadequate

EDITOR, - Goran Isacsson and colleagues suggest that therapeutic failure of antidepressant drugs may be a greater problem in people who commit suicide than toxicity in overdose as their results indicated no advantage of the newer, less toxic drugs; furthermore, their results confirmed that only a small minority of people who commit suicide have received antidepressant treatment before death despite the high prevalence of depression in the population.1 The notable problems in their otherwise impressive database were, however, that they had neither diagnostic information nor knowledge of the dosage used in the cases studied. As our work may contribute to these questions,2 we wish to confirm and extend their findings.

In the national suicide prevention project in Finland all suicides (n=1397) in Finland committed between 1 April 1987 and 31 March 1988 were comprehensively examined by the psychological necropsy method. Mental disorders were evaluated retrospectively, according to the criteria in the Diagnostic and Statistical Manual of Mental, Disorders, third edition, revised, in a diagnostic study of a random sample of 229 suicides.3 In this study 71 of the 229 people who had committed suicide were estimated to have had current unipolar major depression.

Further examination of these 71 people showed that only 22 out of 66 (33%) had received antidepressant treatment (the information concerning possible antidepressant treatment was insufficient in four cases and conflicting in one)2 - a finding similar to the proportion (30%) reported by Barraclough et al in West Sussex.4 Most notably, only two people had received antidepressants in adequate doses (doxepin 250 mg/day and mianserin 60 mg/day). None of the others had received more than an equivalent of 100 mg of a tricyclic antidepressant daily. Thus only 3% (2/66) of people with current major depression who committed suicide were receiving adequate antidepressant …