Background: This paper presents a nationwide analysis of suicide mortality
in Finland from 1990 to 1995, when the total use of antidepressants, especi
ally that by selective serotonin reuptake inhibitors (SSRIs) expanded in th
e country. Methods: Suicide rate was analysed by various methods including
that by intake of antidepressants. Various antidepressants were compared by
calculating fatal toxicity indices (FTI) by relating number of fatal poiso
nings by a drug to its consumption. Results: The expanded use of antidepres
sants coincided with an increased number of deaths caused by these drugs. T
he proportion of suicides committed by use of antidepressants among all sui
cides increased from 5.6% to 8.4%. The total suicide rate, however, decline
d significantly. This was mainly accounted for by the reduced suicide rates
by hanging and carbomonoxide poisoning, which outnumbered the increased fi
gures of suicides by poisoning. On the whole, 82% of suicides by antidepres
sants were committed by use of tricyclics. Use Df doxepin and amitriptyline
remained steady, and their FTIs were constantly high. The lowest FTIs were
associated with fluoxetine, citalopram, mianserin and moclobemide. Limitat
ions: The method ignores causality between the increased use of SSRIs and s
uicide mortality. Various factors affecting risk of suicide or choice of a
method remain outside the scope of the data. Conclusion: The increased use
of SSRIs coincided with a significant decline:in suicide mortality. However
, suicides by use of antidepressants showed an upward trend. Therefore, in
suicide prevention, risks and benefits of antidepressants should be conside
red in choosing treatment for depressive patients. (C) 1998 Elsevier Scienc
e B.V. All rights reserved.