Suicide rates and antidepressant utilization in Russia and its regions

Research concerning the association between use of antidepressants and rates of suicide has yielded inconsistent results. The aims of this study were to evaluate the evolution in the amount and structure of antidepressant consumption at national and regional level in Russian Federation and to investigate the possible relationship between antidepressant sales and trends in suicide rates. Methods. Retrospective analysis of data on antidepressant sales and utilization during a 6-year period (20102015) was performed, applying the ATC/DDD methodology developed by World Health Organization. Consumption data have been expressed in daily-defined dose (DDD) per 1,000 inhabitants per day of treatment (DDD/1000/day) total for hospital, retail and reimbursable pharmaceuticals. The total number of DDD/1000/day was calculated for Russian Federation, for each Federal district and regions of the Russian Federation, by adding up the DDD/1000/day for the individual antidepressants. The association between antidepressant utilization and suicide rates was measured by Spearman’s сorrelation. Findings. The nationwide utilization of antidepressants increased by 1/3 in the studied 6-year period, while suicide rated decreased by one quarter. The usage of tricyclic antidepressants decreased by 13% of the previous value, while the usage of selective serotonin reuptake inhibitors increased by 13%. There was found significant correlation between increased antidepressant consumption and decreased suicide rates at nationwide level for 6-year period by statistical analysis. Suicide rates tended to decrease more in regions with very high suicide rates (i.e., > 20) where there had been a greater increase in the use of antidepressants Conclusions. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.