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. 1995 Jan 28;310(6974):221–224. doi: 10.1136/bmj.310.6974.221

Relative mortality from overdose of antidepressants.

J A Henry 1, C A Alexander 1, E K Sener 1
PMCID: PMC2548619  PMID: 7866123

Abstract

OBJECTIVE--To compare the fatal toxicities of antidepressant drugs in 1987-92. DESIGN--Retrospective epidemiological review of prescription data of the Department of Health, Scottish Office Home and Health Department, and Welsh Health Common Services Authority (excluding data from most private general practices and most hospitals), and mortality data from the Office of Population Censuses and Surveys and General Register Office in Scotland. SETTING--General practice, England, Scotland, and Wales. MAIN OUTCOME MEASURES--Deaths per million prescriptions and deaths per defined daily dose. RESULTS--81.6% (1310/1606) of deaths from antidepressant overdose were due to two drugs, amitriptyline and dothiepin. The overall average of deaths per million prescriptions was 30.1. The overall rate for tricyclic drugs was 34.14 (95% confidence interval 32.47 to 38.86; P < 0.001), monoamine oxidase inhibitors 13.48 (6.93 to 22.19; P < 0.001), atypical drugs 6.19 (4.04 to 8.80; P < 0.001), and selective serotonin reuptake inhibitors 2.02 (0.64 to 4.17; P < 0.001). The numbers of deaths per million prescriptions of amoxapine, dothiepin, and amitriptyline were significantly higher than expected, while nine drugs had a significantly lower number of deaths per million prescriptions than expected. Analysis of deaths per defined daily dose showed a similar pattern. CONCLUSIONS--Safety in overdose should be considered in risk-benefit and cost-benefit considerations of antidepressants. A switch in prescribing, from drugs with a high number of deaths per million prescriptions to drugs with a low number, could reduce the numbers of deaths from overdose. Although this form of suicide prevention can be implemented easily and immediately, its introduction needs to be considered against the higher costs of some of the newer drugs.

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Selected References

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  1. Borys D. J., Setzer S. C., Ling L. J., Reisdorf J. J., Day L. C., Krenzelok E. P. The effects of fluoxetine in the overdose patient. J Toxicol Clin Toxicol. 1990;28(3):331–340. doi: 10.3109/15563659008994434. [DOI] [PubMed] [Google Scholar]
  2. Callaham M., Kassel D. Epidemiology of fatal tricyclic antidepressant ingestion: implications for management. Ann Emerg Med. 1985 Jan;14(1):1–9. doi: 10.1016/s0196-0644(85)80725-3. [DOI] [PubMed] [Google Scholar]
  3. Cassidy S., Henry J. Fatal toxicity of antidepressant drugs in overdose. Br Med J (Clin Res Ed) 1987 Oct 24;295(6605):1021–1024. doi: 10.1136/bmj.295.6605.1021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Dunne F. J. Subcortical dementia. BMJ. 1993 Jul 3;307(6895):1–2. doi: 10.1136/bmj.307.6895.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Forster D. P., Frost C. E. Medicinal self-poisoning and prescription frequency. Acta Psychiatr Scand. 1985 Jun;71(6):567–574. doi: 10.1111/j.1600-0447.1985.tb02550.x. [DOI] [PubMed] [Google Scholar]
  6. Freemantle N., House A., Song F., Mason J. M., Sheldon T. A. Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide. BMJ. 1994 Jul 23;309(6949):249–253. doi: 10.1136/bmj.309.6949.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hatziandreu E. J., Brown R. E., Revicki D. A., Turner R., Martindale J., Levine S., Siegel J. E. Cost utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin. Pharmacoeconomics. 1994 Mar;5(3):249–268. doi: 10.2165/00019053-199405030-00008. [DOI] [PubMed] [Google Scholar]
  8. Henry J. A., Antao C. A. Suicide and fatal antidepressant poisoning. Eur J Med. 1992 Oct;1(6):343–348. [PubMed] [Google Scholar]
  9. Henry J. A. The safety of antidepressants. Br J Psychiatry. 1992 Apr;160:439–441. doi: 10.1192/bjp.160.4.439. [DOI] [PubMed] [Google Scholar]
  10. Henry J. A. Toxicity of antidepressants: comparisons with fluoxetine. Int Clin Psychopharmacol. 1992 Jun;6 (Suppl 6):22–27. [PubMed] [Google Scholar]
  11. Isacsson G., Holmgren P., Wasserman D., Bergman U. Use of antidepressants among people committing suicide in Sweden. BMJ. 1994 Feb 19;308(6927):506–509. doi: 10.1136/bmj.308.6927.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Johnson D. A. Depression: treatment compliance in general practice. Acta Psychiatr Scand Suppl. 1981;290:447–453. doi: 10.1111/j.1600-0447.1981.tb00751.x. [DOI] [PubMed] [Google Scholar]
  13. Jönsson B., Bebbington P. E. What price depression? The cost of depression and the cost-effectiveness of pharmacological treatment. Br J Psychiatry. 1994 May;164(5):665–673. doi: 10.1192/bjp.164.5.665. [DOI] [PubMed] [Google Scholar]
  14. Kapur S., Mieczkowski T., Mann J. J. Antidepressant medications and the relative risk of suicide attempt and suicide. JAMA. 1992 Dec 23;268(24):3441–3445. [PubMed] [Google Scholar]
  15. Montgomery S. A., Henry J., McDonald G., Dinan T., Lader M., Hindmarch I., Clare A., Nutt D. Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates. Int Clin Psychopharmacol. 1994 Spring;9(1):47–53. doi: 10.1097/00004850-199400910-00008. [DOI] [PubMed] [Google Scholar]
  16. Montgomery S. A. The efficacy of fluoxetine as an antidepressant in the short and long term. Int Clin Psychopharmacol. 1989 Jan;4 (Suppl 1):113–119. [PubMed] [Google Scholar]
  17. Nordentoft M., Breum L., Munck L. K., Nordestgaard A. G., Hunding A., Laursen Bjaeldager P. A. High mortality by natural and unnatural causes: a 10 year follow up study of patients admitted to a poisoning treatment centre after suicide attempts. BMJ. 1993 Jun 19;306(6893):1637–1641. doi: 10.1136/bmj.306.6893.1637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Paykel E. S., Freeling P., Hollyman J. A. Are tricyclic antidepressants useful for mild depression? A placebo controlled trial. Pharmacopsychiatry. 1988 Jan;21(1):15–18. doi: 10.1055/s-2007-1014639. [DOI] [PubMed] [Google Scholar]
  19. Spiller H. A., Morse S., Muir C. Fluoxetine ingestion: a one year retrospective study. Vet Hum Toxicol. 1990 Apr;32(2):153–155. [PubMed] [Google Scholar]
  20. Winokur G., Black D. W. Suicide--what can be done? N Engl J Med. 1992 Aug 13;327(7):490–491. doi: 10.1056/NEJM199208133270710. [DOI] [PubMed] [Google Scholar]
  21. Workman E. A., Short D. D. Atypical antidepressants versus imipramine in the treatment of major depression: a meta-analysis. J Clin Psychiatry. 1993 Jan;54(1):5–12. [PubMed] [Google Scholar]

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