Education And Debate

Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide

BMJ 1994; 309 doi: (Published 23 July 1994) Cite this as: BMJ 1994;309:249
  1. N Freemantle,
  2. A House,
  3. F Song,
  4. J M Mason,
  5. T A Sheldon
  1. NHS Centre for Reviews and Dissemination, University of York, York YO1 5DD
  2. Centre for Health Economics, University of York, York Y01 5DD
  3. Department of Liaison Psychiatry, Leeds General Infirmary, Leeds
  1. Correspondence to: Mr Freemantle.
  • Accepted 3 March 1994


Objective: To evaluate a policy to reduce the incidence of suicide by means of changing the prescribing of antidepressants from the older tricyclic antidepressants to the routine first line use of selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants.

Design: Cost effectiveness analysis with sensitivity analyses using observational data on costs, volume of prescribing, deaths, and toxicity.

Setting: United Kingdom primary care. Interventions - Selective serotonin reuptake inhibitors or newer tricyclic and related antidepressants compared with the use of older tricyclics.

Main outcome measures: Cost per life saved and cost per life year saved.

Results: The potential number of lives which may be saved from a switch to the routine first line use of20selective serotonin reuptake inhibitors is between20300 and 450 each year. The cost per life year gained ranges from pounds sterling 19 000 to pounds sterling 173 000, depending on the assumptions used. The cost per life year gained through the use of the newer tricyclic and related antidepressants is considerably lower.

Conclusions: The cost per life year gained through avoiding suicides by the routine first line use20of serotonin reuptake inhibitors is likely to be high. The new tricyclics and related drugs are of similar toxicity to the serotonin reuptake inhibitors but are considerably cheaper and so are more cost effective for this purpose. Further research is required on such prescribing. Because of the great uncertainties the shift to considerably more expensive options must be further investigated.


    • Accepted 3 March 1994
    View Full Text

    Sign in

    Log in through your institution

    Free trial

    Register for a free trial to to receive unlimited access to all content on for 14 days.
    Sign up for a free trial