Increased use of antidepressants and decreasing suicide rates: A population-based study using Danish register data

Objective: The objective of the present study was to examine if the change in the suicide rate is associated with individuals' use of antidepressants as has been suggested by ecological studies. Design: Decomposition of suicide rates by antidepressant treatment group. Setting: Population-based record linkage. Participants: All individuals aged 50 years and older living in Denmark between 1 January 1996 and 31 December 2000 (N = 2 100 808). Main outcome measures: Suicide rates are calculated according to current antidepressant treatment status (no treatment, tricyclic antidepressants (TCA), selective serotonin reuptake inhibitors (SSRI), other antidepressants). The change in the suicide rate during 1996-2000 was decomposed by treatment group. Results: Only one in five older adults dying by suicide was in treatment at the time of death. Whereas the male suicide rate declined by 9.7 suicides per 100 000, recipients of antidepressants contributed to the decline by 0.9 suicides. Women redeeming antidepressant prescriptions accounted for 0.4 suicides of the observed reduction of 3.3 per 100 000. The average suicide rates for men receiving TCA and SSRI were 153.3 and 169.0 per 100 000 person-years, respectively. Among older women, both TCA and SSRI users had an average suicide rate of 68.8 per 100 000 over the period examined. Conclusions: Just a small proportion of older adults dying by suicide were found to be in treatment with antidepressants at the time of death. Individuals in active treatment with antidepressants seem to account for 10% of the decline in the suicide rate. Nevertheless, suicides might be prevented by more effective treatment.