Antidepressant-related deaths and antidepressant prescriptions in England and Wales, 1998-2000

Br J Psychiatry. 2004 Jan:184:41-7. doi: 10.1192/bjp.184.1.41.

Abstract

Background: Deaths from antidepressants continue to account for a substantial proportion of drug-related deaths.

Aims: To investigate the relative toxicity of the major classes of antidepressant drugs, with the specific objective of assessing this in relation to the cause of death; and to analyse the deaths where there were multiple mentions of antidepressant drugs or other psychoactive drugs with antidepressants.

Method: Mortality data were collected from the National Programme of Substance Abuse Deaths, and antidepressant prescription data were collected.

Results: Most deaths from antidepressant drugs were suicides (80%). Tricyclic antidepressants (TCAs) accounted for more drug mentions than did other antidepressant drugs (12 per million prescriptions). Selective serotonin reuptake inhibitors (SSRIs) were associated with a significantly lower risk of toxicity, but 93% of deaths from SSRIs occurred in combination with other drugs, especially TCAs (24.5%). In 'combination' deaths patients were significantly more likely to have had a history of drug misuse.

Conclusions: The efficacy and safety of augmentation therapy with TCAs in SSRI-resistant patients should be monitored carefully, and patients prescribed antidepressants should be screened for drug use/misuse.

MeSH terms

  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / poisoning*
  • Antidepressive Agents, Tricyclic / adverse effects
  • Antidepressive Agents, Tricyclic / poisoning
  • Cause of Death
  • Drug Interactions
  • Drug Overdose / epidemiology
  • Drug Overdose / etiology
  • England / epidemiology
  • Humans
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Selective Serotonin Reuptake Inhibitors / poisoning
  • Substance-Related Disorders / mortality
  • Suicide / statistics & numerical data*
  • Wales / epidemiology

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors