More treatment, same suicide rate

Between 1999 and 2018 the US suicide rate rose 35 percent. in the second half of that stretch the share of adults taking an antidepressant went from 10.6 to 13.8 percent, and the share taking any medication for their mental health kept climbing after that. the rate has been flat since 2018. none of those lines explains another, and the honest version of this page is the three of them side by side, each on its own axis, followed by what researchers say about why they do not move together, and the evidence that cuts the other way.

if you are in crisis in the US, call or text 988. nothing on this page is a reason to start, stop or change a medication; that is a decision to make with your prescriber.

1. the suicide rate, 1900 to 2023

the National Center for Health Statistics publishes death rates back to 1900, recomputed to the age mix of the year 2000 so that years can be compared. for suicide it starts at 13.1 per 100,000, peaks at 21.1 in 1908, falls to 13.4 in 1920, and peaks again at 21.9 in 1932, the worst year of the Depression. that year the rate for men was 35.2 and for women 8.2. it then fell by almost half in twelve years, to 11.5 in 1944.

from 1943 to 2016 the rate never reached 14. from 1945 to 1995 it stayed between 11.4 and 13.7, drifted down to a floor of 10.4 in 2000, and then climbed to 14.2 by 2018. NCHS: “From 1999 through 2018, the suicide rate increased 35%”. the newest brief says the rate “did not significantly change between 2018 and 2023 (14.1)”.

Before 1933 the series covers only the states in the death registration area, which grew from 10 states in 1900 to all 48 in 1933. Each revision of the International Classification of Diseases can break comparability; NCHS says so on every table. The largest is ICD-9 to ICD-10 in 1999. Age adjustment to the 2000 population makes years comparable with each other; it is not the crude rate that was reported at the time.

2. treatment, over the years the rate rose

antidepressants, measured the hard way: NHANES interviewers look at the bottles. the share of adults who had used one in the past 30 days went from 10.6% in 2009–2010 to 13.8% in 2017–2018. the rise was significant for women and not for men. no newer edition of that series exists.

any medication for mental health, by a different survey with a different question: 15.8% of adults in 2019, 19.3% in 2024. the two surveys are not comparable with each other; the usage page has every federal number with the question that produced it.

3. what people report, 2021 to 2025

the national survey that asks people directly has a comparable series only from 2021. in it, adults with a major depressive episode in the past year went from 8.5% to 7.4%, and the fall was almost entirely among adults under 26. serious thoughts of suicide went from 4.9% to 5.3%, and attempts from 0.7% to 0.9%. so while medication use rose (15.8% in 2019 to 19.3% in 2024), reported depression fell a little, suicidal thinking did not fall, and the death rate did not move. the prevalence page breaks these out by age, where the lines go in opposite directions.

4. what the journals call it

this is a named problem in the literature, not a fringe reading. Ormel, Hollon, Kessler, Cuijpers and Monroe (2022) call it the treatment-prevalence paradox: “Treatments for depression have improved, and their availability has markedly increased since the 1980s. Mysteriously the general population prevalence of depression has not decreased.” they test seven explanations. they find “little evidence” that more people are simply being mislabelled or newly ill, and strong evidence that “the published literature overestimates short- and long-term treatment efficacy” and that “treatments are considerably less effective as deployed in "real world" settings”.

Jorm and colleagues (2017) looked at Australia, Canada, England and the US from 1990 to 2015: “the prevalence of mood and anxiety disorders and symptoms has not decreased, despite substantial increases in the provision of treatment, particularly antidepressants.” their best-supported explanation is about quality, not quantity: “much of the treatment provided does not meet the minimal standards of clinical practice guidelines and is not targeted optimally to those in greatest need.” when Australia expanded youth services after 2006, Jorm and Kitchener found “No significant improvement in youth mental health was evident” and a worsening from about 2015.

5. the evidence that points the other way

individuals are not countries. in a Veterans Health Administration analysis of 226,866 patients newly diagnosed with depression, “Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not”, and lower after starting treatment than before. that is observational too, and sicker people are not randomly assigned, but it is the opposite of what the national lines suggest at a glance.

when prescribing fell, the rate did not. after the 2003–2004 warnings about antidepressants and suicidality in young people, SSRI prescriptions for youths fell about 22%. US youth suicides rose 14% between 2003 and 2004, which the authors call the largest year-to-year change since the CDC began collecting the data in 1979. that study is ecological as well, and it has critics, but anyone reading section 1 as proof that the drugs drive the rate has to explain it.

the counterfactual is unknowable. nobody can run the last twenty five years again without the treatment. the rate might have been higher. a CDC study of 1928 to 2007 found that the overall rate “generally rose during recessions and fell during expansions”, most clearly at working ages, and the two highest years on record are years of economic collapse. if money, work, guns and isolation move the rate more than clinics do, flat is what a clinic-only response would look like.

and the recent survey data are not flat. reported depression among adults under 26 fell from 19.3% to 14.2% between 2021 and 2025. nobody knows why, and the report does not say.

what it means if you are the one in treatment

a population line says nothing about whether your treatment is working for you. what the paradox literature does say is useful at the level of one person: outcomes depend on whether the care is any good, whether anyone measures if you are getting better, and whether the things outside the clinic that are making life unlivable get attention too. ask how your progress is being measured. ask what the plan is if the first thing does not work. and never stop a medication on your own; the library has the withdrawal and taper evidence.

Sources

1. CDC/NCHS. HIST293: Age-adjusted death rates for selected causes by race and sex using year 2000 standard population. Death registration states 1900–32 and United States 1933–98 (five tables: 1900–49, 1950–59, 1960–67, 1968–78, 1979–98). Read 2026-09-18. https://www.cdc.gov/nchs/nvss/mortality/hist293.htm
2. Hedegaard H, Curtin SC, Warner M. Increase in Suicide Mortality in the United States, 1999–2018. NCHS Data Brief No. 362, April 2020 (figure 1 data table). https://www.cdc.gov/nchs/products/databriefs/db362.htm
3. Garnett MF, Zehner AM. Changes in Suicide Rates in the United States From 2022 to 2023. NCHS Data Brief No. 541, September 2025. https://doi.org/10.15620/cdc/174625
4. Brody DJ, Gu Q. Antidepressant Use Among Adults: United States, 2015–2018. NCHS Data Brief No. 377, September 2020. https://www.cdc.gov/nchs/products/databriefs/db377.htm
5. NCHS Data Briefs 380 (2019), 419 (2020) and 564 (2024): Mental Health Treatment Among Adults, United States. https://www.cdc.gov/nchs/data/databriefs/db564.pdf
6. SAMHSA. National Survey on Drug Use and Health, annual national reports 2021–2025 (major depressive episode; serious thoughts of suicide; suicide attempts). https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health
7. Ormel J, Hollon SD, Kessler RC, Cuijpers P, Monroe SM. More treatment but no less depression: The treatment-prevalence paradox. Clinical Psychology Review 2022;91:102111. https://doi.org/10.1016/j.cpr.2021.102111
8. Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017;16(1):90–99. https://doi.org/10.1002/wps.20388
9. Jorm AF, Kitchener BA. Increases in youth mental health services in Australia: Have they had an impact on youth population mental health? Aust N Z J Psychiatry 2021;55(5):476–484. https://doi.org/10.1177/0004867420976861
10. Gibbons RD, Brown CH, Hur K, et al. Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 2007;164(9):1356–1363. https://doi.org/10.1176/appi.ajp.2007.07030454
11. Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Mann JJ. Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration data sets. Am J Psychiatry 2007;164(7):1044–1049. https://doi.org/10.1176/ajp.2007.164.7.1044
12. Luo F, Florence CS, Quispe-Agnoli M, Ouyang L, Crosby AE. Impact of business cycles on US suicide rates, 1928–2007. Am J Public Health 2011;101(6):1139–1146. https://doi.org/10.2105/AJPH.2010.300010

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