Journal of Affective Disorders
Volume 102, Issue 1 , Pages 1-9, September 2007

The sales of antidepressants and suicide rates in Norway and its counties 1980–2004

  • Jørgen G. Bramness

      Affiliations

    • Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
    • ,
  • Fredrik A. Walby

      Affiliations

    • The Suicide Research and Prevention Unit, Faculty of Medicine, University of Oslo, Oslo, Norway
    • Diakonhjemmet Hospital, Oslo, Norway
    • Corresponding Author InformationCorresponding author. The Suicide Research and Prevention Unit, University of Oslo, Sognsvannsveien 21, Bygning 12, 2. etg., NO-0320 Oslo, Norway. Tel.: +47 22 92 34 73; fax: +47 22 92 39 58.
    • ,
  • Aage Tverdal

      Affiliations

    • Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway

Received 8 November 2006; received in revised form 30 November 2006; accepted 1 December 2006.

Abstract 

Background

Suicide is a major public health problem and depression is among the most important risk factors for suicide. Treatment of depression might prevent suicide. To study this hypothesis further we conducted an ecological study.

Methods

An ecological study using sales data for antidepressants and numbers of suicides in Norway and Norwegian counties 1980–2004 was performed. Data on alcohol consumption and unemployment rates were registered and taken into account. Data were analyzed using Cochrane-Orcutt time series for the country as a whole. The county specific data were analyzed with a random coefficient model with county as subject and intercept and time (slope) as random variables using an unstructured covariance matrix.

Results

Sales of non-tricyclic antidepressants (non-TCAs) and suicide were clearly negatively related, even when controlling for alcohol and unemployment (adjusted r2: 0.57). There was an effect modification between time and level of sales of non-TCAs. Studying the relationship between the sales of non-TCAs and the suicide rate, we found that it was significant and stronger for the low sales figures, but non-existent for the high sales figures.

Limitations

Ecological studies cannot infer causality.

Conclusions

The fall in suicide rates in Norway and its counties was related to the increased sales of non-TCAs. The effect was mostly a result of a sales increase in the lower sales segment, indicating that a change from the more toxic TCAs, or heightened awareness of depression and its treatment, could explain the relationship found between sales of newer antidepressants and a decrease in suicide rate.

Keywords: Antidepressant, SSRI, Suicide, Ecological study, Pharmacoepidemiology

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PII: S0165-0327(06)00531-3

doi:10.1016/j.jad.2006.12.002

Journal of Affective Disorders
Volume 102, Issue 1 , Pages 1-9, September 2007

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