Association of Suicide and Antidepressant Prescription Rates in Japan, 1999-2003

Department of Neuropsychiatry, Keio University, Edo, Tokyo, Japan
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 07/2007; 68(6):908-16. DOI: 10.4088/JCP.v68n0613
Source: PubMed


We examined the relationship of increasing prescription volume of newer antidepressants, introduced in Japan in 1999, to national rates of suicide.
The relationship between annual changes in rates of suicide (obtained from the Japanese Ministry of Health, Labor, and Welfare Vital Statistics Database) and prescription volume of the newer antidepressants paroxetine, fluvoxamine, and milnacipran (obtained from the database of IMS Japan K.K.), stratified by gender and age groups, was modeled statistically for the years 1999 through 2003. Effects of unemployment and alcohol consumption and the interaction of gender and age with antidepressant prescribing were assessed.
From 1999 through 2003 in Japan, total antidepressant prescriptions increased 57% among males and 50% among females. Approximately 80% of this increase involved the selective serotonin reuptake inhibitors (SSRIs). To reduce a limitation of ecological analysis, we compared annual change in prescription and suicide rates, which eliminates the effect of long-term (secular) linear trends. We found an inverse association between year-to-year changes in the suicide rate and prescription volume of newer antidepressants (fluvoxamine, paroxetine, and milnacipran) (beta = -1.34, p = .008) and SSRIs specifically (fluvoxamine, paroxetine) (beta = -1.41, p = .019). An increase of 1 defined daily dose of SSRI use/1000 population/day was associated with a 6% decrease in suicide rate. Exploratory analysis suggested a stronger association in males, who experienced a greater increase in antidepressant use. Changes in unemployment and alcohol consumption rates did not explain the association.
In Japan during 1999 through 2003, absent long-term linear trend effects, annual increases in prescribing of newer antidepressant medications, mainly SSRIs, were associated with annual decreases in suicide rates, particularly among males.

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    • "The majority of the experimental studies conducted thus far have taken data retrospectively from clinical trials and not analyzed longitudinal datasets with placebo effects, for obvious ethical reasons. Contrary to experimental retrospective studies, some observational studies in several large populations and countries have shown a relative decrease in fatal and nonfatal suicide attempts with greater use of antidepressants.54,55 With the relatively new implication of suicidal risk with short-term antidepressant usage, future studies should aim to uncover more data regarding the long-term and short-term implications of antidepressants in various at-risk suicidal populations. "
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    ABSTRACT: Serotonin is a widely investigated neurotransmitter in several psychopathologies, including suicidal behavior (SB); however, its role extends to several physiological functions involving the nervous system, as well as the gastrointestinal and cardiovascular systems. This review summarizes recent research into ten serotonergic genes related to SB. These genes - TPH1, TPH2, SLC6A4, SLC18A2, HTR1A, HTR1B, HTR2A, DDC, MAOA, and MAOB - encode proteins that are vital to serotonergic function: tryptophan hydroxylase; the serotonin transporter 5-HTT; the vesicular transporter VMAT2; the HTR1A, HTR1B, and HTR2A receptors; the L-amino acid decarboxylase; and the monoamine oxidases. This review employed a systematic search strategy and a narrative research methodology to disseminate the current literature investigating the link between SB and serotonin.
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    • "The negative correlation between antidepressant prescription and national suicide rate in Hungary between 1985 and 2011 is well demonstrated in several previously published papers showing that better recognition and more widespread treatment of depressive disorders, as reflected in the increasing antidepressant utilization, seems to be one of the main contributing factors in the markedly declined suicide rate of Hungary in the last 3 decades [8,21,23,29,34,70]. Similarly, a statistically significant correlation between increasing antidepressant utilization and decreasing national suicide rates have been reported recently from several countries [35,71], including Sweden, Denmark, Finland, Norway [3,72,73], the USA [74], Japan [75] and, as mentioned above, Hungary [8,21,23,29,34,70]. Although ecological association does not mean causality, considering that "
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