Helgason et al (Reference Helgason, Tomasson and Zoëga2004) reported that the dramatic increase in the sales of antidepressants in Iceland had not had any impact on suicide rates. While the sales of antidepressants increased fivefold from 14.9 defined daily doses per 1000 persons per day in 1989 to 72.7 in 2000, the suicide rate remained quite stable (around 11/1000 000 persons per year). The data were, however, not analysed separately by gender.

Based on the World Health Organization database on national suicide rates, Levi et al (Reference Levi, La Vecchia and Lucchini2003) compared the periods 1980–84 and 1995–99, and found that suicide rates in Iceland decreased by 1.7% in males during the whole period (17.9 to 17.6) and by 46.7% in females (from 6.0 to 3.2). In spite of the fact that the time periods investigated by Helgason et al (Reference Helgason, Tomasson and Zoëga2004) and Levi et al (Reference Levi, La Vecchia and Lucchini2003) are not exactly identical, the general trends should be similar. Given this extremely great (27-fold) difference in the decrease in suicide rates between males and females, it would be interesting to see the data on the use of antidepressants in Iceland between 1989 and 2000 for males and females separately. Perhaps the increase in the use of antidepressants was more pronounced in women than in men, as for example in Australia (Reference Hall, Mant and MitchellHall et al, 2003)?

A significant negative correlation between antidepressant prescription and national suicide rates has been reported from Sweden, Denmark, Finland and Norway (Reference IsacssonIsacsson, 2000) as well as from Hungary (Reference RihmerRihmer, 2004), countries where suicide rates have been traditionally high. Statistical association, of course, does not necessarily imply causality, but considering the strong relationship between untreated depression and suicide, the national trends mentioned above point in the expected direction. On the other hand, however, if a marked increase in antidepressant utilisation is not accompanied by a substantial decline in the suicide rate, it does not mean that better and more widespread treatment of depression is not helpful for preventing many suicides. While the overall suicide rate of Australia and Northern Ireland (two countries with traditionally low suicide rates) have not substantially decreased during the past 10 years, a significant association between increased antidepressant use and decreased suicide rates in different age cohorts has been reported (Reference Hall, Mant and MitchellHall et al, 2003; Reference Kelly, Ansari and RaffertyKelly et al, 2003).