THE UTILIZATION OF ANTIDEPRESSANTS - A KEY ISSUE IN THE PREVENTION OFSUICIDE - AN ANALYSIS OF 5281 SUICIDES IN SWEDEN DURING THE PERIOD 1992-1994

Antidepressants detected by the National Department of Forensic Chemis try in 5281 suicides in Sweden during the period 1992-1994 were relate d to data on usage expressed in person-years of exposure. Antidepressa nts were detected in 874 subjects (16.5%). In relation to their use, f luvoxamine, citalopram, moclobemide, mianserin and trimipramine were f ound more often than the reference drug, amitriptyline (i.e. over-risk s). Toxic concentrations of antidepressants were detected in 232 subje cts (4.4%). Most people committing suicide were not taking antidepress ants immediately before their death, even though 40-85% may have been depressed. Undertreatment and therapeutic failure are the main problem s with antidepressants, not the risk of using antidepressants in overd ose. Comparisons of new antidepressants should focus on efficacy in re lation to reference tricyclics. The huge increase in the use of antide pressants in Sweden since 1990-1991 has been paralleled by a significa nt decrease in suicide rates.