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Relative mortality from overdose of antidepressants
J A Henry1, C A Alexander, E K Sener
1National Poisons Unit, Guy's Hospital, London.
BMJ (Clinical Research Ed.)
|January 28, 1995
Summary
Fatal toxicities of antidepressants vary significantly. Amitriptyline and dothiepin showed the highest overdose deaths, while newer antidepressants like SSRIs were safer. Prescribing shifts could reduce antidepressant overdose deaths.
Area of Science:
- Pharmacovigilance
- Epidemiology
- Public Health
Background:
- Antidepressant overdose deaths pose a significant public health concern.
- Understanding the comparative fatal toxicities of different antidepressant classes is crucial for risk management.
Purpose of the Study:
- To compare the fatal toxicities of various antidepressant drugs prescribed between 1987 and 1992.
- To identify specific antidepressant medications associated with higher rates of overdose fatalities.
Main Methods:
- A retrospective epidemiological review of prescription and mortality data from general practices in England, Scotland, and Wales.
- Analysis of deaths per million prescriptions and deaths per defined daily dose.
Main Results:
- Amitriptyline and dothiepin accounted for 81.6% of antidepressant overdose deaths.
- Tricyclic antidepressants (34.14 deaths/million prescriptions) had a higher fatality rate than monoamine oxidase inhibitors (13.48), atypical drugs (6.19), and selective serotonin reuptake inhibitors (2.02).
- Amoxapine, dothiepin, and amitriptyline showed significantly higher-than-expected deaths per million prescriptions.
Conclusions:
- Antidepressant safety in overdose is a critical factor in risk-benefit and cost-benefit analyses.
- Shifting prescribing from high-fatality drugs to safer alternatives could decrease overdose deaths.
- While easily implemented, this suicide prevention strategy requires consideration of the higher costs associated with newer antidepressants.