Antidepressants in suicide: differences in fatality and drug utilisation

Area of Science:

• Forensic Toxicology
• Psychopharmacology
• Public Health

Background:

• Antidepressant drug use has increased globally.
• Understanding the role of antidepressants in mortality is crucial for public health.
• Forensic data can provide insights into drug-related deaths.

Purpose of the Study:

• To investigate the association between antidepressant drug levels found in forensic autopsy cases and antidepressant sales data.
• To identify specific antidepressant drugs most frequently involved in suicides.
• To explore potential reasons for variations in drug involvement in deaths.

Main Methods:

• Analysis of 272 forensic autopsy cases with detectable antidepressant drugs in southern Sweden (1986-1989).
• Comparison of drug findings with antidepressant sales data (defined daily doses per 1,000 inhabitants per day).
• Categorization of cases into suicide by antidepressants, suicide by other means, and other deaths.

Main Results:

• Amitriptyline was the most common antidepressant found in suicides and the most frequently sold.
• Trimipramine was most frequently implicated as a causal agent in suicides when corrected for sales volume.
• Lofepramine, despite high sales, was rarely involved in deaths, possibly due to lower toxicity or absorption issues.

Conclusions:

• The study highlights varying risks associated with different antidepressant drugs in suicide cases.
• Sales data and toxicity profiles are important factors in assessing drug-related mortality.
• Further research is needed to understand the clinical and toxicological factors influencing antidepressant-related deaths.