Antidepressants are the cornerstone of treatment of depressive disorders in health care. Their efficacy in treating depression is indisputable, although it leaves room for improvement. However, recent reports also suggest that antidepressants might, in some rare cases, actually worsen suicidal tendencies instead of alleviating them.

In numerous psychological autopsy studies conducted worldwide, more than 90% of subjects completing suicide were shown to have suffered from mental disorders. Suicides have multiple causes and should therefore not be seen as merely consequences of mental disorders.

Depression is the most important single factor predisposing to suicide, and more than half of all subjects completing suicide are known to have suffered from depression. Thus, any treatment that is widely available, safe, and efficacious in alleviating depression is plausible for purposes of suicide prevention.

Thus, reducing the severity and the duration of a depressed state by antidepressant treatment is likely to be an effective preventive measure for suicidal acts, and alleviation of depression and hopelessness can be reasonably expected to result in disappearance of suicidal thoughts.

Depression is present in more than half of suicides, but in the majority of these suicides it had been untreated at the time. Therefore, improved recognition and treatment of depressed patients in primary care along with improved access to psychiatric services is a key prevention strategy for suicide.

In some short-term randomized clinical trials of antidepressants for depression in children and adolescents, antidepressants are found to be associated with a slightly higher proportion (0.7%) of patients reporting suicidal ideation or a suicide attempt than control patients receiving placebo. It is important to note that there are no completed suicides in these studies. Adults treated with SSRI antidepressants in randomized clinical trials have a similar risk of either non-fatal self harm or suicidal thoughts than those on placebo.

Most importantly, there is no evidence for increased national suicide rates due to increased use of antidepressants. Antidepressants reduce the severity, and the time a patient spends in a depressive state, which are credible factors in reducing the risk for suicidal acts.