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Related Experiment Videos

SSRI safety in overdose

J T Barbey1, S P Roose

  • 1Division of Clinical Pharmacology, Georgetown University Medical Center, Washington, DC, USA.

The Journal of Clinical Psychiatry
|October 24, 1998
PubMed
Summary
This summary is machine-generated.

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Selective serotonin reuptake inhibitor (SSRI) antidepressants are significantly safer in overdose than tricyclic antidepressants (TCAs). Few fatalities occur with SSRI-only overdoses, though co-ingestion increases toxicity.

Area of Science:

  • Pharmacology
  • Toxicology
  • Clinical Medicine

Background:

  • Tricyclic antidepressant (TCA) overdose is associated with significant morbidity and mortality.
  • Selective serotonin reuptake inhibitors (SSRIs) are newer antidepressants with a perceived improved safety profile in overdose.
  • Understanding SSRI overdose characteristics is crucial for clinical management and public health.

Purpose of the Study:

  • To describe the clinical signs, symptoms, and mortality associated with selective serotonin reuptake inhibitor (SSRI) overdoses.
  • To compare the safety of SSRIs in overdose with that of TCAs.
  • To identify factors influencing SSRI overdose toxicity.

Main Methods:

  • Literature review of English-language articles from MEDLINE (1985-1997).

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  • Analysis of case reports from the American Association of Poison Control Centers (AAPCC) (1987-1996).
  • Review of United States Food and Drug Administration (FDA) adverse event database (through 1997) for SSRI overdoses.

    • Main Results:

    • SSRI antidepressants are rarely fatal when taken alone in overdose.
    • Moderate SSRI overdoses (up to 30x daily dose) typically cause minor symptoms or are asymptomatic.
    • High-dose SSRI ingestions (>75x daily dose) can lead to seizures, ECG changes, and decreased consciousness.
    • Co-ingestion of alcohol or other drugs with SSRIs significantly increases toxicity and is implicated in nearly all SSRI-related fatalities.

    Conclusions:

    • Selective serotonin reuptake inhibitors (SSRIs) demonstrate a far superior safety profile in overdose compared to tricyclic antidepressants (TCAs).
    • No significant differences in overdose safety were observed among different SSRI medications.
    • The primary risk factor for severe outcomes in SSRI overdose is co-ingestion with other substances.