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Tijdschrift voor Psychiatrie 44 (2002) 10, 693 - 702

Essay

Disappointments

H.M. van Praag

background The last forty years therapeutic opportunities for depression increased considerably with the advent of modern antidepressants. It seems logical to assume that the frequency of suicide and suicide attempts will show a sharp decline over this period.
aim The question is discussed whether the suicide frequency did decline over the past forty years.
method
Literature search using Medline and articles referred to in papers and monographs.
results Controlled, prospective and large-scale studies on suicide frequency within defined populations are scarce. Some investigators report (modest) decreases. These publications, however, are overshadowed by recently published large meta-analyses of placebo controlled studies into the effects of antidepressants and placebo on suicidal behavior in depression. Those concluded that no effect is demonstrable. In this paper a number of possible explanations of these observations is discussed.
conclusion Convincing data that modern antidepressants brought about a general reduction of the frequency of suicide and suicide attempts are lacking. These findings are of great importance clinically, as well as scientifically. They should not be swept under the carpet because they do not fit today's expert opinions. Thorough studies as to the reasons why are in order.

keywords antidepressants, depression, psychogenesis, stress research, suicide