[Suicide and psychotropic drugs].

Suicide provocates 0.5 to 1% of the deaths in France. Suicide appears to be closely related to psychiatric morbidity. History of depression is associated with a 30-fold increase in suicide risk. Globally, the annual incidence of suicide among depressives is 1% and 15% of the depressives die by suicide. When depressive symptoms are retrospectively assessed, it appears that 45 to 70% of patients who committed suicide presented depression. Suicide is the main complication of untreated depression. Patients who commit suicide take the more easily available medications. The decrease in the prescription of barbiturates has been associated with a decrease of the frequency of self-poisoning with barbiturates. In the same time, neuroleptics, antidepressants and benzodiazpines, more often prescribed, induced more lethality by suicide. The number of deaths by millions of prescriptions variates, with the antidepressants, between 13 and 166. They correspond to 0.005% of death each year among patients taking antidepressants. In daily practice, the prescription of antidepressants, which alleviates depressive symptoms, usually prevents suicidal risk among depressives. In some rare cases, antidepressants and other psychoactive agents are used by the patients, in overdosage, to commit suicide. According to the results of all controlled studies of antidepressants, suicide attempts are more frequent among patients taking antidepressants (1.7% of the cases) than among patients receiving placebo (0.8%). These data may be related to methodological bias which are discussed here. They do not initiate to restrain the prescription of antidepressants to depressed patients but to provide more frequent consultations and even to hospitalize depressives at high risk for suicide.