We would like to offer a slightly different perspective from De Leo (Reference De Leo2002) on the progress of suicide prevention. There is no argument against suicide representing a complex set of variables. The general method of science, however, is to analyse phenomena in order to find the most simple explanation — the principle formulated by William of Occam in the early 14th century. In the medical paradigm, death results from a disease process. Studying people with heart attacks led to the identification of atherosclerosis as the underlying disease process for the vast majority. Treating myocardial infarctions is important. The development of various approaches to prevention and treatment of atherosclerosis has, however, prevented more premature deaths from heart attacks. Why must one conclude that suicide is a more complicated medical problem than myocardial infarction?

A fundamental discovery was made in the late 1950s (Reference Robins, Murphy and WilkinsonRobins et al, 1959): the majority of suicides were committed by people with clinical depression. This finding has been replicated over and over again and we believe that many, like us, have concluded that this connection has been replicated enough to be proven. We have also presented evidence that suicides occur infrequently in people with depression taking antidepressant medication (Reference Isacsson, Bergman and RichIsacsson et al, 1994).

Thus, in spite of the ‘extreme complexity’ of the phenomenon of suicide, a simple and testable hypothesis can be stated: depression is a necessary cause of most suicides. Based on this proposition, it has been suggested that effective suicide prevention must focus on improving identification and treatment of depression in the population (Reference IsacssonIsacsson, 2000). When we look at the declining suicide rates over the past decade or so, we see a great deal of support for that theory. Since the introduction of the new generation of antidepressants during the past 10-15 years, the use of antidepressants has increased up to 5-fold. Concurrently, suicide rates have decreased considerably in many Western countries (e.g. Reference JoyceJoyce, 2001). It appears to us that we are getting closer to suicide prevention.

We believe that a lack of focus on depression as the basic disease leading to suicide is most likely the reason why the current decline in suicide rates ‘seems reasonably unrelated to the existence of any national plan’.