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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

BMJ 2008; 336 doi: (Published 06 March 2008) Cite this as: BMJ 2008;336:542
  1. Benedict W Wheeler, research fellow1,
  2. David Gunnell, professor of epidemiology1,
  3. Chris Metcalfe, lecturer in medical statistics1,
  4. Peter Stephens, vice president, public health affairs2,
  5. Richard M Martin, reader in clinical epidemiology1
  1. 1Department of Social Medicine, University of Bristol, Bristol BS8 2PR
  2. 2IMS Health, London
  1. Correspondence to: B W Wheeler ben.wheeler{at}
  • Accepted 17 December 2007


Objective To investigate the population impact on the incidence of suicide and non-fatal self harm of regulatory action in 2003 to 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 (prescribing trends), 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 admissions for self harm.

Results Antidepressant prescribing doubled between 1999 and 2003 but fell to the 1999 level between 2004 and 2005. These large changes in prescribing did not seem to be associated with temporal trends in suicide or self harm. In the years 1993 to 2005 the annual percentage reduction for suicide among 12-17 year 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 this rate of decrease during that period. Similarly, hospital admission rates for self harm in the years 1999 to 2005 indicated an annual percentage 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 statistical evidence of a change in rate after the regulatory action.

Conclusions The noticeable reduction in prescribing of antidepressants since regulatory action in 2003 to restrict the use of SSRIs in under 18s does not seem to have been associated with changes in suicidal behaviour in young people. Specifically, these data for England do not indicate that reductions in antidepressant use have led to an increase in suicidal behaviour.


  • Research, doi: 10.1136/bmj.39475.603935.25
  • Hospital Episode Statistics data were provided through agreements with the South West Public Health Observatory. We thank Anita Brock at the Office for National Statistics for mortality data. Nicos Middleton supplied annual antidepressant data for 1993-98.

  • Contributors: RMM, DG, and CM had the original idea for the study and obtained funding. BWW collected and analysed data, and drafted the methods, results, and discussion. He is the guarantor. CM advised and assisted with statistical analysis. PS supplied prescribing data and assisted with analysis and interpretation. All authors contributed to various drafts and approved the final draft.

  • Funding: This study was supported by a grant from the Medicines and Healthcare products Regulatory Agency (grant No SDS003); the agency approved the study design during the funding process but aside from this the authors carried out the study and publication independently without further involvement of the funder.

  • Competing interests: DG was a member of the Medicines and Healthcare products Regulatory Agency expert working group on the safety of SSRIs. He acted as an independent adviser, receiving travel expenses and a small fee for attending meetings and reading materials in preparation for the meeting. Data from IMS Health are used by both the pharmaceutical industry and the Medicines and Healthcare products Regulatory Agency.

  • Ethical approval: Not required.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

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