Background and aim: Overall, suicide rates in the Nordic region, Denmark, Finland, Iceland, Norway and Sweden, have declined in the past 40 years. The aim of this study was to determine trends in suicide mortality from 2000 to 2018. Methods: Data were obtained from official suicide statistics for men and women, 15 years and older. Gender and age groups in four calendar periods were analyzed using Joinpoint Estimated Regression Coefficient. Results: The crude regional suicide rate was 17.1, 2000–2004, decreased to 14.1 per 100,000 inhabitants in 2015–2018. Age-standardized rates are 13.6–11.3. The crude rate decreased by 19.5% (16.3% age-standardized), 19.3% for males and 20.5% for females. The largest decrease was found in Finland (34.9%), the smallest in Norway (1.4%). In males, the exception was an increased suicide rate among all Icelandic except 15–24-year olds, and in 45–64 year-old Norwegians. Among females, an increase was seen among 15–24-year olds in all countries except Iceland, in all age groups in Norway, and in 25–44-year olds in Sweden. In males, a decline of the suicide rated lower than 10% was noted in 25–44 olds in Norway and in 15–64 year-olds in Sweden. Discussion: A robust decrease was observed in the overall regional suicide rate in recent years. Exceptions are rising rates in Icelandic males, in Norwegian females, and the youngest female groups in all except Iceland. The small decline among middle-aged males in Norway and Sweden is of concern.