Antidepressant-related deaths and antidepressant prescriptions in England and Wales, 1998-2000.
BACKGROUND
Deaths from antidepressants continue to account for a substantial proportion of drug-related deaths.


OBJECTIVE
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.


METHODS
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.
Cheeta
Survjit
S
Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London, UK. scheeta@sghms.ac.uk
Schifano
Fabrizio
F
Oyefeso
Adenekan
A
Webb
Lucy
L
Ghodse
A Hamid
AH
D000928:Antidepressive Agents / Q000009:adverse effects / Q000506:poisoning*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000506:poisoning; D002423:Cause of Death; D004347:Drug Interactions; D062787:Drug Overdose / Q000453:epidemiology / Q000209:etiology; D004739:England / Q000453:epidemiology; D006801:Humans; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000506:poisoning; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data*; D014852:Wales / Q000453:epidemiology
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors