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. 2006 Jun;3(6):e190.
doi: 10.1371/journal.pmed.0030190. Epub 2006 Jun 13.

Modeling of the temporal patterns of fluoxetine prescriptions and suicide rates in the United States

Michael S Milane  1 , Marc A Suchard, Ma-Li Wong, Julio Licinio
Affiliations

Modeling of the temporal patterns of fluoxetine prescriptions and suicide rates in the United States

Michael S Milane et al. PLoS Med. 2006 Jun.

Abstract

Background: To study the potential association of antidepressant use and suicide at a population level, we analyzed the associations between suicide rates and dispensing of the prototypic SSRI antidepressant fluoxetine in the United States during the period 1960-2002.

Methods and findings: Sources of data included Centers of Disease Control and US Census Bureau age-adjusted suicide rates since 1960 and numbers of fluoxetine sales in the US, since its introduction in 1988. We conducted statistical analysis of age-adjusted population data and prescription numbers. Suicide rates fluctuated between 12.2 and 13.7 per 100,000 for the entire population from the early 1960s until 1988. Since then, suicide rates have gradually declined, with the lowest value of 10.4 per 100,000 in 2000. This steady decline is significantly associated with increased numbers of fluoxetine prescriptions dispensed from 2,469,000 in 1988 to 33,320,000 in 2002 (r(s) = -0.92; p < 0.001). Mathematical modeling of what suicide rates would have been during the 1988-2002 period based on pre-1988 data indicates that since the introduction of fluoxetine in 1988 through 2002 there has been a cumulative decrease in expected suicide mortality of 33,600 individuals (posterior median, 95% Bayesian credible interval 22,400-45,000).

Conclusions: The introduction of SSRIs in 1988 has been temporally associated with a substantial reduction in the number of suicides. This effect may have been more apparent in the female population, whom we postulate might have particularly benefited from SSRI treatment. While these types of data cannot lead to conclusions on causality, we suggest here that in the context of untreated depression being the major cause of suicide, antidepressant treatment could have had a contributory role in the reduction of suicide rates in the period 1988-2002.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Age-Adjusted Suicide Rates at the Population Level
(A) Age-adjusted suicide rates (per 100,000) for the total population from 1960 to 2002 and fluoxetine prescribed numbers (in millions) from 1988 to 2002 (B) Age-adjusted suicide rate predictions for the total population. The solid lines trace out the posterior median model predictions and the dashed lines depict the 95% Bayesian credible intervals. The top red line depicts the predicted suicide rates without fluoxetine and the bottom black line represents the actual rates with fluoxetine. (C) This figure demonstrates the linear relationship between suicide rates and fluoxetine prescription numbers.
Figure 2
Figure 2. Age-Adjusted Suicide Rates by Sex
(A and B) Suicide rates (per 100,000) for the total female (A) and male (B) populations from 1960–2002. (C and D) Age-adjusted suicide rate predictions for the female (C) and male (D) populations. Solid lines trace out the posterior median model predictions and the dashed lines depict the 95% Bayesian credible intervals. The top red line depicts the predicted suicide rates without fluoxetine and the bottom black line represents the current rates with fluoxetine.
Figure 3
Figure 3. Estimated Number of Lives Saved Since 1988–2002 with the Advent of SSRIs
Data are shown as a posterior median prediction with 95% Bayesian credible intervals.
See this image and copyright information in PMC

Comment in

  • Is it just a marker for increased care?
    Hockey R. Hockey R. PLoS Med. 2006 Sep;3(9):e406; author reply e407. doi: 10.1371/journal.pmed.0030406. PLoS Med. 2006. PMID: 17002507 Free PMC article. No abstract available.
  • Were Eli Lilly unaware of this study?
    Reidak A. Reidak A. PLoS Med. 2006 Sep;3(9):e408; author reply e407. doi: 10.1371/journal.pmed.0030408. PLoS Med. 2006. PMID: 17002509 Free PMC article. No abstract available.
  • Fluoxetine and suicide rates: suicide and the economy.
    Camargo CA, Bloch DA. Camargo CA, et al. PLoS Med. 2006 Nov;3(11):e501; author reply e504. doi: 10.1371/journal.pmed.0030501. PLoS Med. 2006. PMID: 17132055 Free PMC article. No abstract available.

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