Document Detail


Suicidal antidepressant overdoses: a comparative analysis by antidepressant type.
MedLine Citation:
PMID:  19031375     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The safety of antidepressants following overdose is critical because of the high risk of suicide attempts in depressed patients. This study was conducted to decrease the fatality rate of antidepressant overdoses by providing data to shift prescribing toward safer antidepressants.
METHODS: US poison control data for 2000-2004 were analyzed by 25 antidepressant types. Medical outcome differences were quantified using a hazard index (number of major or fatal outcomes per 1000 reported antidepressant ingestions).
RESULTS: Of 82,802 suicidal single-agent ingestions of identifiable antidepressants approved for use in the US, cases occurred predominantly in females and peaked in teens. Fatal cases peaked at 40 to 49 years of age. Suicidal ingestions of the SSRIs, SNRIs, and other antidepressants peaked in teens, lithium in the twenties, tricyclics and tetracyclics in the thirties, and MAO inhibitors in the forties. There were 40 major or fatal outcomes per 1000 cases. Weighted by antidepressant type, the mean hazard index for the 25 antidepressants was 79 (range: 0 to 292). Amoxapine (292), maprotiline (211), and desipramine (187) had the highest hazard indices. The tricyclic antidepressants, MAO inhibitors, maprotiline, and bupropion were in the more severe half of antidepressants, ranked by hazard index. All SSRIs had low hazard indices. Hazard index and exposure frequency were inversely correlated (R = -0.423, p = 0.035), while hazard index and use of critical care were positively correlated for the 25 antidepressant types (R = 0.797, p < 0.001). Clinical effect profiles for each antidepressant type are presented.
CONCLUSION: Suicidal overdose severity varied considerably by antidepressant type. Prescribing decisions should be informed by regularly updated comparative overdose severity data.
Authors:
Nicole White; Toby Litovitz; Cathleen Clancy
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of medical toxicology : official journal of the American College of Medical Toxicology     Volume:  4     ISSN:  1556-9039     ISO Abbreviation:  J Med Toxicol     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-25     Completed Date:  2009-02-24     Revised Date:  2013-08-01    
Medline Journal Info:
Nlm Unique ID:  101284598     Medline TA:  J Med Toxicol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  238-50     Citation Subset:  IM    
Affiliation:
University of Virginia School of Medicine, Charlottesville, VA, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic Uptake Inhibitors / poisoning
Adult
Age Factors
Aged
Antidepressive Agents / poisoning*
Antidepressive Agents, Tricyclic / poisoning
Antimanic Agents / poisoning
Child
Drug Overdose
Female
Humans
Lithium Chloride / poisoning
Male
Middle Aged
Monoamine Oxidase Inhibitors / poisoning
Serotonin Uptake Inhibitors / poisoning
Sex Factors
Suicide / statistics & numerical data*
Suicide, Attempted
Treatment Outcome
United States / epidemiology
Young Adult
Chemical
Reg. No./Substance:
0/Adrenergic Uptake Inhibitors; 0/Antidepressive Agents; 0/Antidepressive Agents, Tricyclic; 0/Antimanic Agents; 0/Monoamine Oxidase Inhibitors; 0/Serotonin Uptake Inhibitors; 7447-41-8/Lithium Chloride
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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