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

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  • Author(s): Milane MS;Milane MS; Suchard MA; Wong ML; Licinio J
  • Source:
    PLoS medicine [PLoS Med] 2006 Jun; Vol. 3 (6), pp. e190. Date of Electronic Publication: 2006 Jun 13.
  • Publication Type:
    Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Public Library of Science Country of Publication: United States NLM ID: 101231360 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1549-1676 (Electronic) Linking ISSN: 15491277 NLM ISO Abbreviation: PLoS Med Subsets: MEDLINE
    • Publication Information:
      Original Publication: San Francisco, CA : Public Library of Science, [2004]-
    • Subject Terms:
      Antidepressive Agents, Second-Generation/*therapeutic use ; Depressive Disorder/*drug therapy ; Depressive Disorder/*psychology ; Fluoxetine/*therapeutic use ; Suicide/*trends; Drug Utilization/statistics & numerical data ; Drug Utilization/trends ; Female ; Humans ; Male ; Practice Patterns, Physicians' ; Regression Analysis ; Suicide/statistics & numerical data ; United States
    • 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.
    • Comments:
      Comment in: PLoS Med. 2006 Sep;3(9):e406; author reply e407. (PMID: 17002507)
      Comment in: PLoS Med. 2006 Sep;3(9):e408; author reply e407. (PMID: 17002509)
      Comment in: PLoS Med. 2006 Nov;3(11):e501; author reply e504. (PMID: 17132055)
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    • Grant Information:
      U01 GM061394-01S1 United States GM NIGMS NIH HHS; U01 GM061394-03 United States GM NIGMS NIH HHS; M01 RR000865-310708 United States RR NCRR NIH HHS; R03 HG002500-01S1 United States HG NHGRI NIH HHS; K12 RR017611 United States RR NCRR NIH HHS; HG002500 United States HG NHGRI NIH HHS; RR000865 United States RR NCRR NIH HHS; R01 DK063240 United States DK NIDDK NIH HHS; U01 GM061394-03S1 United States GM NIGMS NIH HHS; M01 RR000865 United States RR NCRR NIH HHS; U01 GM061394-05 United States GM NIGMS NIH HHS; U01 GM061394-04 United States GM NIGMS NIH HHS; MH062777 United States MH NIMH NIH HHS; R03 HG002500-01 United States HG NHGRI NIH HHS; DK063240 United States DK NIDDK NIH HHS; U01 GM061394-06 United States GM NIGMS NIH HHS; RR017365 United States RR NCRR NIH HHS; K30HL04526 United States HL NHLBI NIH HHS; U01 GM061394-01 United States GM NIGMS NIH HHS; R03 HG002500 United States HG NHGRI NIH HHS; R03 HG002500-02 United States HG NHGRI NIH HHS; U01 GM061394 United States GM NIGMS NIH HHS; K24 RR016996 United States RR NCRR NIH HHS; GM61394 United States GM NIGMS NIH HHS; K30 HL004526 United States HL NHLBI NIH HHS; R03 HG002500-02S1 United States HG NHGRI NIH HHS; K24 RR017365 United States RR NCRR NIH HHS; RR16996 United States RR NCRR NIH HHS; R01 DK063240-02 United States DK NIDDK NIH HHS; M01 RR000865-338780 United States RR NCRR NIH HHS; U01 GM061394-07 United States GM NIGMS NIH HHS; K12RR17611 United States RR NCRR NIH HHS; U01 GM061394-02 United States GM NIGMS NIH HHS; U01 GM061394-04S1 United States GM NIGMS NIH HHS; U01 GM061394-02S1 United States GM NIGMS NIH HHS; U01 GM061394-06S1 United States GM NIGMS NIH HHS; K24 RR016996-06 United States RR NCRR NIH HHS; R01 DK063240-01 United States DK NIDDK NIH HHS
    • Accession Number:
      0 (Antidepressive Agents, Second-Generation)
      01K63SUP8D (Fluoxetine)
    • Publication Date:
      Date Created: 20060614 Date Completed: 20071101 Latest Revision: 20220311
    • Publication Date:
      20240829
    • Accession Number:
      PMC1475655
    • Accession Number:
      10.1371/journal.pmed.0030190
    • Accession Number:
      16768544