May 8, 2003 -- The surge in antidepressant use over the last decade may have played an important role in suicide prevention. A new Australian study shows increases in antidepressant prescribing were closely correlated with a decline in suicide rates, especially among the elderly.
Experts say links between antidepressant prescribing and suicide trends on a nationwide level don't necessarily mean that antidepressant use reduces the risk of suicide on an individual basis. But they say the findings provide further evidence that effective treatment of depression is a vital tool in suicide prevention.
The study, published in the May 10 issue of the British Medical Journal, looked at the association between trends in antidepressant prescribing and suicide rates in Australia from 1991 to 2000.
Researchers found the overall suicide rate for Australian men and women over age 15 did not change, but they did find significant differences between age groups in terms of suicide risk and antidepressant prescribing habits.
"We found a steep increase in antidepressant prescribing in Australia from 1991 to 2000, which unlike in earlier studies, was not accompanied by a decline in overall rates of suicide because there was a large increase in suicide in young people over the same time period," write researcher Wayne D. Hall, director of the Office of Public Policy and Ethics at the University of Queensland in Brisbane, Australia, and colleagues.
"There was, however, a strong association between the groups with high exposure to antidepressants and the groups in which the rate of suicide fell," they write. "The groups with the highest antidepressant exposure showed the largest declines in suicide."
While the study does not show a cause and effect relationship between antidepressant use and suicide risk, researchers say there are good reasons to believe that increased antidepressant prescribing can contribute to suicide prevention.
First, depression is a major risk factor for suicide, and use of antidepressants reduces suicidal tendencies among people with depression. Second, a prescription for antidepressants is often accompanied by other medical interventions and counseling that may reduce suicidal behavior.
Finally, researchers say the introduction of selective serotonin reuptake inhibitors (SSRIs) that are less likely to cause dangerous drug interactions or side effects than older types of antidepressants has made primary care doctors more likely to prescribe antidepressants to their patients without referring them to a specialist. That means patients have greater access to medications to treat depression and other mental disorders that are risk factors for suicide.
Treating Depression is Only One Part of Suicide Prevention
"Depression is the number one risk factor for suicide. Of those that commit suicide, 40% to 70% have a diagnosis of depression," says Douglas Jacobs, MD, professor psychiatry at Harvard Medical School and founder of National Depression Screening Day. "However, the majority of people with depression do not commit suicide."
Jacobs says increased antidepressant use has also been associated with a drop in the suicide rate in the U.S. over the last decade, but it's difficult to prove definitively that greater antidepressant use is fueling the decline because suicide is such a complicated issue.
"The public should understand that antidepressants are correlated with a reduction of the suicide rate, but any one case of depression has to be treated very individually," Jacobs tells WebMD. "Unfortunately suicides do occur even in those taking medicine."
Herbert Hendin, medical director of the American Foundation for Suicide Prevention and professor of psychiatry at New York Medical College, says improved use of medicines that treat depression are just one aspect of suicide prevention.
He says that while SSRIs have made depression treatment easier for both doctor and patient, effective suicide prevention requires more than just prescribing antidepressants.
"You can identify depressed persons who are suicidal from ones who are not," says Hendin. "There are differences emotionally. [Suicidal people] tend to be angrier, more anxious, and they are very often in a state of desperation, and if they don't get immediate relief they feel life is intolerable."
Hendin says many people with depression are not receiving adequate doses of antidepressants or all the other necessary medications, such as anti-anxiety drugs, to treat their depression appropriately and effectively lower their suicide risk. But he says there are also people for whom an antidepressant may be the first step in suicide prevention.
"Sometimes there will be people trapped in a situation that is making them miserable, and you can't cure it simply with antidepressants," Hendin tells WebMD. "Sometimes [with antidepressants] you give them enough energy, but then you have to help them get out of that miserable situation."