Fatal intoxication with antidepressants: a case with many culprits

Area of Science:

• Pharmacology
• Cardiology
• Genetics

Background:

• Serotonin-specific reuptake inhibitors (SSRIs) are commonly prescribed antidepressants.
• Polypharmacy, the use of multiple medications, poses risks, particularly in vulnerable populations.
• Undiagnosed cardiovascular conditions can exacerbate drug-related adverse events.

Observation:

• A young adult with bipolar disorder was prescribed two SSRIs (citalopram, fluoxetine) and a monoamine oxidase inhibitor (MAO; moclobemide).
• The individual had undiagnosed hypertrophic cardiomyopathy.
• Genetic analysis suggested a potential predisposition to increased SSRI sensitivity.

Findings:

• The combination of SSRIs and MAO inhibitor led to fatal adverse effects.
• The co-occurrence of polypharmacy, contraindicated medications, and an underlying heart condition was implicated in the death.
• Establishing the manner of death was complicated by these interacting factors.

Implications:

• This case underscores the critical importance of comprehensive patient evaluation, including cardiac screening, before prescribing serotonergic medications.
• It highlights the potentially lethal consequences of drug interactions and polypharmacy, even in young individuals.
• The findings emphasize the need for careful consideration of genetic predispositions in psychopharmacology.