Suicide rates and antidepressant prescribing: a casual or causal relationship

Abstract

In an ecological study in this issue of PLoS Medicine, Milane and colleagues found a temporal association between prescription of specific serotonin reuptake inhibitor (SSRI) antidepressants and suicide rates in the United States [1]. Their study addresses a subject of great public health importance and clinical interest. The researchers asked the question: was the use of antidepressants associated with a change in suicide rates in the general population of the United States between 1988 and 2002? There were two underlying hypotheses: (1) antidepressants can trigger suicide and subsequently increase suicide rates, and (2) through the treatment of depression with antidepressants, suicide rates decline over time.