Treating suicidality in depressive illness. Part I: current controversies

To consider 2 current controversies about the treatment of depressed suicidal patients: 1) whether they are undertreated by physicians and 2) whether the increase in antidepressant prescribing in recent years is responsible for the observed fall in suicide rates in some countries.

Systematic review of the literature. Analysis of Canadian data.

There is evidence that depressive illness in suicidal persons has been undertreated, but there has been improvement, possibly in response to enhanced public and professional awareness. There continues to be public resistance to taking antidepressants and (among men) to seeking professional help for suicidal depression. Because of inconsistencies, the epidemiologic evidence (although sometimes compelling) remains inconclusive for attributing the decline in suicide rates in some countries to the increase in new-generation antidepressants supply.

Physicians should aggressively pursue recognition and treatment of depression and suicidality but not put their entire faith in medication. Suicide is the product of complex factors that become the person's individual predicament, some of them beyond the capacity of antidepressant drugs to control. The physician should endeavour to assist the patient either to alter the personal predicament or to come to terms with it, as well as prescribing medication appropriately.