Antidepressant prescription and suicide rates: equivocal relationships

Numerous ecological studies have shown an inverse association between newer antidepressant use (prescribing as proxy) and national suicide rates (SR) in most countries. Geographic regions or demographic and social groups with the highest antidepressant prescription rates have the lowest SR. The strongest association was found in the oldest age groups, where the increase in antidepressant use was highest. Although some contires do not show such correlations, potential reasons include lack of compliance; pre-existing low SR, resulting in a floor effect; and high rates of alcoholism that may elevate SR or the effect may be confined to women because too few men seek and comply with treatment with antidepressants. The risk of an ecological fallacy, that is, inferring causality from group correlations, prevents attributing decreases in SR solely to antidepressant use. Nevertheless, there is a striking correlation and plausible mechanism linking antidepressant use to declining SR. This may be a consequence of improved treatment of antidepressant-responsive psychiatric illnesses that increase SR, mainly depression, but studies emphasize the importance of the quantity and quality of the depression treatment as a componrnt of suicide prevention.