Relationship between antidepressant sales and secular trends in suicide rates in the Nordic countries

Background The effect of recent increases in antidepressant prescribing on population suicide rates is uncertain. Aims To investigate the relationship between antidepressant sales and trends in suicide rates. Method Graphical and quantitative assessment of trends in suicide and antidepressant sales in Norway, Sweden, Denmark and Finland. Results Suicide rates declined in all four countries during the 1990s, whereas antidepressant sales increased by 3- to 4-fold. Decreasing suicide rates in Sweden and Denmark preceded the rise in anti depressant sales by over 10 years, although the reductions accelerated between 1988 and 1990. In Norway, a modest but short-lived decline in suicide rates began around the time of the increase in antidepressant sales. In Finland, decreases in male suicide rates and to a lesser extent in female suicide rates began around the time of increased antidepressant sales. In all four countries decreases in suicide rates appeared to precede the widespread use of SSRIs. Conclusions We found mixed evidence that increases in antidepressant sales have coincided with a reduction in the number of suicides in Nordic countries. Declaration of interest D.G. was a member of the Medicines and Healthcare products Regulatory Agency Expert Working Group on the Safety of SSRIs. He was an independent advisor, receiving expenses and an attendance fee.