Association Between Antidepressant Prescribing and Suicide in Australia, 1991-2000: Trend Analysis

In many developed countries the number of prescriptions for antidepressants increased steeply during the 1990s, after the introduction of selective serotonin reuptake inhibitors (SSRIs). In some countries the increased rate of prescribing coincided with fall in the suicide rate. 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. 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. 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 after the introduction of SSRIs in the early 1990s and rates of suicide declined, despite steep increases in unemployment and per capita alcohol consumption.

Contrary to these positive findings, however, in Italy Barbui et al did not find any association between suicide rates and antidepressant use for 1986-96, during which time SSRIs were introduced. 

We examined the association between changes in antidepressant prescribing in Australia for 1991-2000 and changes in rates of suicide. We analyzed differences in suicide trends between men and women in different age groups to assess whether age and sex rates in suicide were related to differences between age and sex groups in exposure to antidepressant medication. We also examined any differences between age and sex groups in rates of antidepressant prescribing and whether these were related to trends in suicide rates in these age and sex groups.