Since 2003, the Food and Drug Agency (FDA) issued a number of advisory warnings regarding the association between use of antidepressants (ADs) and suicidal behavior, especially among young people. These warnings have led to a more restrictive use of ADs, also among adults.

We investigated the rates of (fatal) suicide attempts associated with different classes of ADs at different ages.

To contribute to finding a favorable balance between safety and the challenge to offer efficacious treatment.

By linking the Psychiatric Case Register Middle-Netherlands, which contains patients of psychiatric services in the Utrecht region, Agis Health Database, which contains registered insurance claims, and the death register of Statistics Netherlands, rates of (fatal) suicide attempts were estimated.

For 7,725 patients with a depressive disorder (mean age 43.2 years) and with at least one AD delivery, 35,224 episodes of use, 23,840 episodes of no use, 32 suicide events, and 357 suicide attempts were established. No significant differences were found in suicide and suicide attempt rates between the different classes of ADs. Compared to episodes of no use, episodes of use of ADs were significantly associated with higher frequency of suicide attempts but suicide rates were similar. A trend towards an unfavorable effect of ADs on suicide risk at younger age was found (P = 0.0718).

Our results support the FDA advisories in which ADs are treated alike. Use of ADs is indicative of a high risk of suicide, which reiterates the need for close monitoring of patients, especially at young age.