Sunday, May 11, 2003
By Ed Edelson
FRIDAY, May 9 (HealthScoutNews) -- An increase in prescriptions for antidepressants in Australia has been accompanied by a decrease in suicides among older people, and there are good reasons to believe the association is cause and effect.
It's not so much the antidepressants themselves, but the indication that family doctors are paying more attention to the psychological stress that can lead to suicide, says Dr. Andrea Mant, an associate professor of public health and community medicine at the University of Queensland. She is lead author of a report on the finding in the May 10 issue of the British Medical Journal.
"What really has been going on is an increasing role of general practitioners in recognizing symptoms of depression and responding to them," Mant says.
Mant and her colleagues got the year-by-year numbers on suicides between 1991 and 2000 from the Australian Bureau of Statistics, and the numbers on antidepressant prescriptions for different age groups from IMS Health Australia, the leading international provider of data on drug use. Then they calculated the change in suicide rates in relation to each age group's use of antidepressants.
The overall suicide rate did not change, the report says, but there were marked decreases for older men and women. "The largest declines in suicide occurred in the age groups with the highest exposure to antidepressants," the researchers write.
When the researchers looked at other possible reasons for the decline -- less drinking, improvement in the quality of life, more unemployment -- they didn't find a relationship. So it seems to be medical treatment, and not necessarily the use of antidepressants alone, Mant says.
The arrival of a new class of antidepressants, selective serotonin reuptake inhibitors, has promoted the use of such drugs. They have fewer side effects, such as sedation, and fewer interactions with other drugs than older antidepressants, she says. Having such drugs available has made doctors less reluctant to treat depression, she adds.
"We believe this is a proxy for more people coming to their doctors with problems and the general practitioners taking steps to help them," Mant says.
It's a "fascinating" study, the largest of its kind, says Dr. Alan Swann, a spokesman for the American Foundation for Suicide Prevention. But he is careful to add that "this kind of study doesn't tell you that anyone was prevented from committing suicide by taking antidepressants."
"This reinforces what practitioners are already taught, that anyone who is depressed needs to be evaluated for the possibility of suicide," says Swann, a professor of psychiatry at the University of Texas Medical School in Houston.
There is a tendency to romanticize suicide, he says, but the fact is that "almost everyone who commits suicide is in the throes of a major psychiatric illness -- depression, schizophrenia or bipolar disorder. And they are all treatable."
You can learn more about the warning signs of suicide and what to do about them from the American Foundation for Suicide Prevention or the National Institute of Mental Health.