| Suicidal antidepressant overdoses: a comparative analysis by antidepressant type. | |
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MedLine Citation:
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PMID: 19031375 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Nicole White; Toby Litovitz; Cathleen Clancy |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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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:
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Created Date: 2008-11-25 Completed Date: 2009-02-24 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101284598 Medline TA: J Med Toxicol Country: United States |
Other Details:
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Languages: eng Pagination: 238-50 Citation Subset: IM |
Affiliation:
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University of Virginia School of Medicine, Charlottesville, VA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adrenergic Uptake Inhibitors / poisoning Adult Age Factors Aged Antidepressive Agents / poisoning* Antidepressive Agents, Tricyclic / poisoning Antimanic Agents / poisoning Child Female Humans Lithium Chloride / poisoning Male Middle Aged Monoamine Oxidase Inhibitors / poisoning Overdose Serotonin Uptake Inhibitors / poisoning Sex Factors Suicide / statistics & numerical data* Suicide, Attempted Treatment Outcome United States / epidemiology Young Adult |
| Chemical | |
Reg. No./Substance:
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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 |
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