Abstract
From each case of suicide and drug-related death autopsied in the Institute of Forensic Medicine, Munich during the years 2001–2005, a toxicological investigation on anti-depressants (AD) was performed. In 180 suicides and 72 narcotic drug death cases, ADs were detected: 4 different classic tricyclic anti-depressants (TCAs), 6 other non-selective monoamine re-uptake inhibitors (NSMRIs), 5 selective serotonin re-uptake inhibitors (SSRIs) and 3 other ADs. The suicides were grouped further according to the type of suicide (violent or non-violent). The prescription frequency of the ADs in Germany, expressed as the defined daily dosages (DDDs), during the investigated years served for comparison. There were serious differences in the frequency of different ADs regarding to the manner of suicide. In cases associated with doxepin and trimipramine, non-violent suicides were distinctly over-represented, as in cases in which the drug itself was responsible for the death as in cases of non-violent suicides in other manners. In contrast, in cases with citalopram or opipramol, violent forms of suicides were significantly over-represented. For amitriptyline, the ratio was approximately balanced. For the remainder of the ADs, the case numbers were too low for a valid evaluation. The different frequency distributions of the ADs, associated with violent and non-violent suicides may be explained by their different pharmacological active profiles and the different lethality of overdoses of the different ADs. There was no indication at all for a special suicidal problem of SSRIs in juveniles. Amongst 1,127 suicides within 5 years, in an area with approximately 5 million people, the youngest suicide victim with SSRIs was 28 years old. In drug death cases, citalopram was obviously over-represented.
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Acknowledgment
The authors would like to thank Mrs. Birgit Övgüer for the competent chemical toxicological analysis of the blood and urine samples and Mr. Manfred Wimmer for the computerised selection of the cases.
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The authors confirm that this study was not sponsored by third parties, especially not by any pharmaceutical company.
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Drasch, G., Dahlmann, F., von Meyer, L. et al. Frequency of different anti-depressants associated with suicides and drug deaths. Int J Legal Med 122, 115–121 (2008). https://doi.org/10.1007/s00414-007-0178-2
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DOI: https://doi.org/10.1007/s00414-007-0178-2