Depression is the most important single factor predisposing to suicide, and more than half of all subjects completing suicide are known to have suffered from depression. Unfortunately, depression is still often untreated or undertreated, even after a suicide attempt. Antidepressive drugs represent the cornerstone of treatment of depressive patients. However, their role has become somewhat controversial over the last few years due to reports suggesting that antidepressants might, in a small subgroup of younger patients (recently estimated at 0.7% in clinical trials) actually worsen suicidal tendencies instead of alleviating them.
As a consequence, regulatory authorities in many countries have reconsidered their cost-benefit ratio. On the other hand, in many western countries, increasing use of antidepressants on the national and regional level correlates, as expected with declining suicide mortality, and in no country has an increase in suicides due to antidepressants been reported.
While there is no doubt that potential side effects of antidepressive medication concerning suicidal behaviour are a very serious issue, it is important to obtain a balanced view of all the clinical and epidemiological facts pertaining to the effect of antidepressive therapy in relation to suicidal behaviour.
Professor Erkki Isometsä, a renowned expert in psychiatric suicide research, will present the state of evidence and critically comment on the current discussion concerning this topic with regard to the role of antidepressive treatment in real-life clinical practice.