Antidepressant prescribing and suicide

Editor—Hall et al say that reductions in suicide rates in older people in Australia could be attributed to their increased exposure to antidepressants, in particular selective serotonin reuptake inhibitors.¹ But the associations seem to attribute possible causality inappropriately.

According to the Australian Bureau of Statistics, suicide rates in people over the age of 40 in Australia have gradually reduced since 1961-5, the peak period of suicide deaths for these age groups since the great depression.² This is true for each five year age group from age 40 years. In most age groups, the greatest reduction occurred in the period before 1990. For example, in 1961-5 suicide rates in men aged 45-9 were 34.9 per 100 000 and in men aged 50-4 39.4 per 100 000. In 1986-90 rates had dropped to 23.5 per 100 000 and 24.7 per 100 000 respectively. By 1996-2000 the rate had dropped to 23.8 per 100 000.

Similarly if we examine men aged 55-64 years, from 1961-5 to 1986-90 suicide rates dropped from 37.8 per 100 000 to 25.1 per 100 000 and to 20.7 in 1996-2000. This scale of pre-1990 suicide rate reductions is also found in women.

Important historical trends of a reduction in suicides prevailed long before selective serotonin reuptake inhibitors were introduced. The reasons for this reduction are unclear, but improved detection and treatment of depression is unlikely to be as effective in preventing suicide as the prevention of depression itself.