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P0126 - Forensic toxicology of 16,937 suicides in Sweden 1995-2005 indicates that the increased use of antidepressants caused the decrease in suicide

Published online by Cambridge University Press:  16 April 2020

G. Isacsson
Affiliation:
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
A. Holmgren
Affiliation:
National Board of Forensic Medicine, Linkoping, Sweden
U. Osby
Affiliation:
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
P. Sparen
Affiliation:
Department of Medicial Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
J. Ahlner
Affiliation:
National Board of Forensic Medicine, Linkoping, Sweden

Abstract

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Background and Aims:

Accumulating evidence supports the hypothesis that antidepressant treatment prevents suicide. Most of this evidence consists of studies demonstrating decreases in suicide in parallel with increased use of antidepressants in different populations. Since ecological studies cannot establish causality, this individual-based study, analyzing temporal patterns in the toxicology of all suicides in Sweden 1992-2005, aimed at testing the hypothesis that the substantial decrease in suicide during the period was caused by the increased use of antidepressants.

Methods:

During the eleven years, 16,937 suicides, and 33,426 controls (natural or accidental deaths) were investigated by toxicological screening. The annual numbers of detections of antidepressants, zolpidem, zopiclone, tramadole, and dextropropoxyphene were analysed in suicides and controls.

Results:

The annual number of suicides decreased by 332 cases (18.6 %). The expected number of antidepressant positive suicides, as determined only by their increased use in controls, was 741. If the decrease in suicide was caused by antidepressants, the expected number of suicides with antidepressants in toxicology should be reduced with 332 cases i.e. 409. If the decrease in suicide was not caused by antidepressants the expected number of positive cases should be reduced by 18.6 %, i.e. 603. The observed number was 420, indicating causality. The other drugs were detected as expected if they had not caused the decrease in suicide.

Conclusion:

This controlled individual-based naturalistic study indicates that the increased use of antidepressants was the cause of the decrease in suicide previously demonstrated in ecological studies. Definite conclusions cannot be drawn, however.

Type
Poster Session III: Forensic Psychiatry
Copyright
Copyright © European Psychiatric Association 2008
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