Antidepressant prescribing and changes in antidepressant poisoning mortality and suicide in England, 1993-2004.

BACKGROUND In England, the impact of increased use of antidepressant medications is unclear. We examine associations between antidepressant use, suicide and antidepressant poisoning mortality, adjusted for important covariates. METHODS Data on suicide and antidepressant poisoning mortality were provided by the Office for National Statistics. Prescription data were provided by the Department of Health. Age- and sex-specific prescribing rates were estimated from The Health Improvement Network primary care data. We measured the association between prescribing, suicide and poisoning mortality after adjusting for age, sex, calendar year, prescribing rates and use of newer antidepressants drugs. RESULTS The prevalence of antidepressant treatment increased during the 1990s for all age and sex groups. Treatment prevalence remained constant from 2002 but declined among children and adolescents. Between 1993 and 2004, age-standardized rates for suicide decreased from 98.2 to 81.3 per million populations and for antidepressants from 9.2 to 7.4 per million populations. Before adjustment, increased antidepressant prescribing was associated with a decrease in suicide (r(s) = -0.90, P < 0.001) and antidepressant poisoning mortality rates (r(s) = -0.65, P = 0.023). This association disappeared after adjustment. CONCLUSION In England, at a population level, there does not appear to be an association between antidepressant prescribing and antidepressant poisoning mortality or suicide.

[1]  Robert D Gibbons,et al.  The relationship between antidepressant prescription rates and rate of early adolescent suicide. , 2006, The American journal of psychiatry.

[2]  D. Aizenberg,et al.  Association between antidepressant prescribing and suicide in Israel , 2006, International clinical psychopharmacology.

[3]  M. Suchard,et al.  Modeling of the Temporal Patterns of Fluoxetine Prescriptions and Suicide Rates in the United States , 2006, PLoS medicine.

[4]  D. Gunnell,et al.  Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries , 2006, British Journal of Psychiatry.

[5]  B. D'avanzo,et al.  Antidepressant drug consumption and public health indicators in Italy, 1955 to 2000. , 2005, The Journal of clinical psychiatry.

[6]  Jens Ludwig,et al.  Anti-depressants, suicide, and drug regulation. , 2005, Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management].

[7]  Robert D Gibbons,et al.  The relationship between antidepressant medication use and rate of suicide. , 2005, Archives of general psychiatry.

[8]  A. DeMaris.  Introduction to Regression Modeling , 2005 .

[9]  J. Ledolter,et al.  Introduction to Regression Modeling , 2005 .

[10]  A. Majeed,et al.  Association between mortality from suicide in England and antidepressant prescribing: an ecological study , 2004, BMC public health.

[11]  M. Oquendo,et al.  Antidepressants and suicide risk in the United States, 1985-1999. , 2004, The Journal of clinical psychiatry.

[12]  D. Gunnell,et al.  Antidepressants and suicide: what is the balance of benefit and harm , 2004, BMJ : British Medical Journal.

[13]  S. Wessely,et al.  Active placebos versus antidepressants for depression. , 2004, The Cochrane database of systematic reviews.

[14]  M. Stevenson,et al.  Antidepressant prescribing and suicide rate in Northern Ireland , 2003, European Psychiatry.

[15]  M. Olfson,et al.  Relationship between antidepressant medication treatment and suicide in adolescents. , 2003, Archives of general psychiatry.

[16]  I. Hickie,et al.  Association between antidepressant prescribing and suicide in Australia, 1991-2000: trend analysis , 2003, BMJ : British Medical Journal.

[17]  J. Ranstam,et al.  Antidepressant medication and suicide in Sweden , 2001, Pharmacoepidemiology and drug safety.

[18]  T. Kendrick,et al.  Treatment delivery and guidelines in primary care. , 2001, British medical bulletin.

[19]  S. Kalmár,et al.  Antidepressants and suicide prevention in Hungary , 2001, Acta psychiatrica Scandinavica.

[20]  G Isacsson,et al.  Suicide prevention — a medical breakthrough? , 2000, Acta psychiatrica Scandinavica.

[21]  R D Farmer,et al.  The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared. , 2000, Journal of affective disorders.

[22]  D. Gunnell,et al.  Trends in suicide in England and Wales , 2000, British Journal of Psychiatry.

[23]  I. Anderson,et al.  Selective serotonin reuptake inhibitors versus tricyclic antidepressants: a meta-analysis of efficacy and tolerability. , 2000, Journal of affective disorders.

[24]  J. Deakin,et al.  Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines , 2000 .

[25]  Mark Woodward,et al.  Epidemiology: Study Design and Data Analysis , 1999 .

[26]  J. Lonnqvist,et al.  Antidepressants and suicide mortality. , 1998, Journal of affective disorders.

[27]  R G Priest,et al.  The Defeat Depression Campaign: psychiatry in the public arena. , 1997, The American journal of psychiatry.

[28]  K. Demyttenaere.  Compliance during treatment with antidepressants. , 1997, Journal of affective disorders.

[29]  R G Priest,et al.  Lay people's attitudes to treatment of depression: results of opinion poll for Defeat Depression Campaign just before its launch , 1996, BMJ.

[30]  J. Ormel,et al.  Recognition and treatment of mental illness in primary care. Towards a better understanding of a multifaceted problem. , 1995, General hospital psychiatry.

[31]  R. Farmer,et al.  The Limitations of Official Suicide Statistics , 1995, British Journal of Psychiatry.

[32]  J. Henry,et al.  Relative mortality from overdose of antidepressants , 1995, BMJ.

[33]  H. Jick,et al.  Antidepressants and suicide , 1995, BMJ.

[34]  R G Priest,et al.  Recognition and management of depression in general practice: consensus statement. , 1992, BMJ.

[35]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[36]  J. Sterne,et al.  Combining individual and ecological data to determine compositional and contextual socio-economic risk factors for suicide. , 2007, Social science & medicine.

[37]  J. Savarino,et al.  Suicide risk during antidepressant treatment. , 2006, The American journal of psychiatry.

[38]  Matz Dahlberg,et al.  Antidepressants and the suicide rate: is there really a connection? , 2005, Advances in health economics and health services research.

[39]  A. Majeed,et al.  Fatal toxicity of antidepressants in England and Wales, 1993-2002. , 2004, Health statistics quarterly.

[40]  S. Wessely,et al.  Active placebos versus antidepressants for depression (Review) , 2004 .

[41]  Ashok N. Singh,et al.  The new generation of antidepressants. , 2003, Hospital medicine.

[42]  T. Walley,et al.  Average daily quantities: a tool for measuring prescribing volume in England , 2000, Pharmacoepidemiology and drug safety.

[43]  J. Deakin,et al.  Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. British Association for Psychopharmacology. , 2000, Journal of psychopharmacology.

[44]  A. Berghöfer,et al.  Antidepressants and suicidal risk. , 1999, The Journal of clinical psychiatry.

[45]  S. Kelly,et al.  Drug-related mortality: methods and trends. , 1998, Population trends.