There have been concerns about the risk benefit ratio of treatment with antidepressants and antipsychotics in the light of recent evidence pointing to a risk of suicide induction during the course of treatment with antidepressants. These concerns have led to a series of recent studies exploring national rates of suicide and correlating these with data on antidepressant consumption, which apparently showed reductions in suicides since the advent of the SSRIs.

The data from controlled trials on antidepressants and antipsychotics however point to increased suicide and suicide attempt rates. Against this background we have looked at suicide rates in schizophrenia in North Wales from the pre- and post-antipsychotic eras and have compared suicide rates in the Nordic countries with autopsy and ill-defined death rates, and antidepressant sales, during the period 1961 through to 2003.

There has been a 10-fold rise in suicide rates in schizophrenia since the introduction of the antipsychotics. In the Nordic countries, there is no relationship between antidepressant consumption and suicide rates but a close correlation between suicide rates and both autopsy and ill-defined death rates, which appear to need further clarification.

Combined these datasets suggest efforts to reduce suicide rates, in particular efforts that rely on psychotropic drug use may be quixotic.