title: Contributory and incidental blood concentrations in deaths involving citalopram.
abstract: All cases presenting to the New South Wales Department of Forensic Medicine between January 1, 2001 and December 31, 2010 in which citalopram was detected were retrieved. A total of 348 cases were identified. Citalopram contributed to death in 21.0%, and was incidental in 79.0%. Cases in which citalopram was contributory to death had significantly higher blood citalopram concentrations than incidental cases (0.50 mg/L vs. 0.30 mg/L). Citalopram concentrations varied significantly by contributory status: sole citalopram toxicity (median = 1.30 mg/L), citalopram/other drug toxicity (0.50 mg/L), and incidental cases (0.30 mg/L). Citalopram concentrations also varied by suicide status, with the highest concentration found in suicides where citalopram contributed to death (0.70 mg/L) compared with 0.50 mg/L for nonsuicide cases where citalopram contributed to death. In almost all contributory cases (69/73), other psychoactive substances were also detected, most commonly benzodiazepines (47.9%), alcohol (45.2%), and opioids (40.1%).
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, 2052, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Darke
authors.forename: Michelle
authors.initials: M
authors.lastname: Torok
authors.forename: Johan
authors.initials: J
authors.lastname: Duflou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018687:Antidepressive Agents, Second-Generation / Q000097:blood* / Q000506:poisoning; D002492:Central Nervous System Depressants / Q000097:blood; D015283:Citalopram / Q000097:blood* / Q000506:poisoning; D000431:Ethanol / Q000097:blood; D005260:Female; D053593:Forensic Toxicology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000097:blood; D009517:New South Wales / Q000453:epidemiology; D011619:Psychotropic Drugs / Q000097:blood; D012189:Retrospective Studies; D013405:Suicide / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D002492:Central Nervous System Depressants; D009294:Narcotics; D011619:Psychotropic Drugs; D015283:Citalopram; D000431:Ethanol
keywords: citalopram; forensic science; polydrug; suicide; toxicity; toxicology