International impacts of regulatory action to limit antidepressant prescribing on rates of suicide in young people


  • DG is a member of the MHRA's Pharmacovigillance Expert Advisory Group. He acts as an independent advisor, receiving travel expenses and a small fee for meeting attendance and reading materials in preparation for the meeting. BW, CM and RM all declare no conflict of interest, and no financial interest.



Concerns that selective serotonin reuptake inhibitors (SSRIs) may increase the risk of suicidal behaviour amongst young people led to regulatory action in 2003/4 in many countries. Antidepressant prescribing to young people in various countries declined, but subsequent analyses have demonstrated mixed effects on population suicide rates.


Annual, national suicide mortality rates from 1990 to 2006 for 10–19 year-olds in World Health Organisation (WHO) Mortality Stratum A countries were studied using the WHO mortality database. Departures from country-specific trends in 2004–2006 relative to overall trends 1990–2006 were calculated to estimate the impact of regulatory actions in 2003/4.


There was no consistent change in rate after 2003, with some countries experiencing more and some fewer suicides than expected. Amongst 15–19 year olds the rate ratio was 0.999 (95%CI: 0.971–1.028), and in 10–14 year olds was 0.999 (95%CI: 0.929–1.074). There was some evidence of differential results for males and females. In 15–19 year olds there were 1.8% fewer (95%CI: −5.0 to +1.5%) suicides than expected amongst males and 8.1% more (95%CI: +1.9 to +14.6%) suicides than expected amongst females during 2004–2006. Rate ratios for 10–14 year-olds demonstrated a similar pattern, but with much greater uncertainty.


There was no evidence of an overall effect on suicides of regulatory action to restrict prescribing of SSRIs to young people, although there was weak evidence of an increase in suicide amongst young women internationally. Copyright © 2009 John Wiley & Sons, Ltd.