Psychopharmacology of suicide

Abstract

The papers which follow were presented in a symposium on the Psychopharmacology of Suicide in association with the Annual General Meeting, British Association for Psychopharmacology at the Royal Society, London, on April 23rd 1982. As both joint editor of the Journal and chairman of the symposium, I am pleased to present them to the readership. They represent the first implementation of a decision by the Editorial Board to publish topical symposia of relevance. Three phenomena are under discussion in these papers: depression, attempted suicide and suicide. It is widely recognised that, although they overlap, they are distinct. A large proportion of non-fatal suicide attempters do not show the full depressive syndrome, particularly with endogenous or biological symptoms. Estimates of the proportion of actual suicides who are depressed vary a great deal, but it is clear that suicide is not limited to clinical depressives. The differentiation between attempted suicide and suicide is enshrined in such terms as ‘parasuicide’. The impact of psychopharmacology on the two suicidal phenomena has received surprisingly little attention. One approach is to look for some impact on the rates of occurrence over time. If drugs are truly effective we might expect to see suicidal phenomena decline. Internationally there were dramatic increases in prescribing rates for psychotropic drugs in the 1960s and the 1970s. In examining detailed trends it is easier to use figures for a single country. In Great Britain good data are available on prescription rates for psychotropic drugs since the early 1960s from the prescription analyses and reports of the Department of Health and Social Security. The data, which are summarised in Fig. 1 show the familiar increases for antidepressants and benzodiazepine minor tranquillisers throughout the 1960s and the first half of the 1970s. What is less well known is that since 1975 the British increase appears to have ceased, with rates which are stable or have fallen slightly. The suicide rate might be most responsive to antidepressants or to the earlier introduction of ECT. British national statistics show a decline in the suicide rates through the 1960s and 1970s. Expressed approximately the annual rate for males dropped from around 150 per 100,000 in the early 1960s to 100 per 100,000 in the