title: Fatality caused by a combined trimipramine-citalopram intoxication.
abstract: A 53-year-old woman who was diagnosed as suffering from depression was found dead in her bed. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs trimipramine (2.33 mg/l), citalopram (4.81 mg/l) and zolpidem (0.07 mg/l) were identified in the femoral blood. A combined drug intoxication resulting in synergistic effects to cardiovascular disorders was proposed as the cause of death. An acute overdose and suicide was suggested by calculation of the parent drug to main metabolite ratios in femoral blood and liver tissue. The trimipramine to desmethyltrimipramine ratios were calculated to be 2.06 and 3.18, the citalopram to desmethylcitalopram ratios were 1.96 and 2.02.
authors.affiliation: Institute of Legal Medicine, Rheinische Friedrich-Wilhelms-University, Bonn, Germany. f.musshoff@uni-bonn.de
authors.forename: F
authors.initials: F
authors.lastname: Musshoff
authors.forename: P
authors.initials: P
authors.lastname: Schmidt
authors.forename: B
authors.initials: B
authors.lastname: Madea
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000097:blood / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000097:blood / Q000506:poisoning*; D015283:Citalopram / Q000031:analogs & derivatives / Q000097:blood / Q000506:poisoning*; D003863:Depression / Q000188:drug therapy; D062787:Drug Overdose; D004357:Drug Synergism; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000097:blood / Q000506:poisoning; D008099:Liver / Q000737:chemistry; D008875:Middle Aged; D011725:Pyridines / Q000097:blood / Q000506:poisoning; D013405:Suicide; D014299:Trimipramine / Q000031:analogs & derivatives / Q000097:blood / Q000506:poisoning*; D000077334:Zolpidem
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D006993:Hypnotics and Sedatives; D011725:Pyridines; D015283:Citalopram; C046304:desmethylcitalopram; D014299:Trimipramine; D000077334:Zolpidem; C040606:desmethyltrimipramine