Skip to main content
SpringerLink
Log in

Newer antidepressants: evaluation of fatal toxicity index and interaction with alcohol based on Finnish postmortem data

  • Original Article
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

Finnish postmortem toxicology data from 1995 to 2002 was analyzed to obtain improved estimates of fatal toxicity indices for the newer antidepressants and to evaluate their interaction with alcohol. Altogether 284 fatal poisonings were attributed to 12 different newer antidepressants. Venlafaxine, mianserin, moclobemide, and mirtazapine were responsible for significantly more deaths than expected from their sales. Their fatal toxicity indices were higher than those of selective serotonin reuptake inhibitors (SSRIs) but lower than those of tricyclic antidepressants. In fatal poisonings involving alcohol in combination with venlafaxine, mianserin, moclobemide, or mirtazapine, the median blood alcohol concentration (BAC) ranged from 2.35 to 2.7 mg/g, whereas in those involving alcohol in combination with citalopram or fluoxetine the median BAC was 2.9 and 3.4 mg/g, respectively. The BAC was significantly lower in venlafaxine-related deaths than in those involving fluoxetine or citalopram. We conclude that among the newer antidepressants differences are present both in toxicity and in interaction potential with alcohol. The SSRIs appear to present a low risk of fatal poisoning when taken alone or in combination with alcohol, whereas venlafaxine is associated with an elevated risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Anderson IM (2001) Meta-analytical studies on new antidepressants. Br Med Bull 57:161–178

    Google Scholar 

  2. Peretti S, Judge R, Hindmarch I (2000) Safety and tolerability considerations: tricyclic antidepressants vs. selective serotonin reuptake inhibitors. Acta Psychiatr Scand, Suppl 403:17–25

    Google Scholar 

  3. Nelson JC (1997) Safety and tolerability of the new antidepressants. J Clin Psychiatry 58:26–31

    Google Scholar 

  4. Barbey JT, Roose SP (1998) SSRI safety in overdose. J Clin Psychiatry 59(Suppl 15):42–48

    Google Scholar 

  5. Henry JA, Alexander CA, Sener EK (1995) Relative mortality from overdose of antidepressants. Br Med J 310:221–224

    Google Scholar 

  6. Whyte IM, Dawson AH, Buckley NA (2003) Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. QJM 96:369–374

    Google Scholar 

  7. Ray WA, Meredith S, Thapa PB, Hall K, Murray KT (2004) Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther 75:234–241

    Google Scholar 

  8. Delgado PL (2004) How antidepressants help depression: mechanisms of action and clinical response. J Clin Psychiatry 65(Suppl 4):25–30

    Google Scholar 

  9. Elhwuegi AS (2004) Central monoamines and their role in major depression. Prog Neuro-Psychopharmacol Biol Psychiatry 28:435–451

    Google Scholar 

  10. Cheeta S, Schifano F, Oyefeso A, Webb L, Ghodse AH (2004) Antidepressant-related deaths and antidepressant prescriptions in England and Wales, 1998–2000. Br J Psychiatry 184:41–47

    Google Scholar 

  11. Frey R, Schreinzer D, Stimpfl T, Vycudilik W, Berzlanovich A, Kasper S (2000) Suicide by antidepressant intoxication identified at autopsy in Vienna from 1991–1997: the favourable consequences of the increasing use of SSRIs. Eur Neuropsychopharmacol 10:133–142

    Google Scholar 

  12. Buckley NA, McManus PR (2002) Fatal toxicity of serotoninergic and other antidepressant drugs: analysis of United Kingdom mortality data. Br Med J 325:1332–1333

    Google Scholar 

  13. Cassidy S, Henry J (1987) Fatal toxicity of antidepressant drugs in overdose. Br Med J 295:1021–1024

    Google Scholar 

  14. Öhberg A, Vuori E, Klaukka T, Lönnqvist J (1998) Antidepressants and suicide mortality. J Affect Disord 50:225–233

    Google Scholar 

  15. Koski A, Ojanperä I, Vuori E (2003) Interaction of alcohol and drugs in fatal poisonings. Human Exp Toxicol 22:281–287

    Google Scholar 

  16. Jönsson A, Holmgren P, Ahlner J (2004) Fatal intoxications in a Swedish forensic autopsy material during 1992–2002. Forensic Sci Int 143:53–59

    Google Scholar 

  17. Vuori E, Ojanperä I, Rasanen I (1997) Fatal poisonings in Finland during 1993–1995 based on forensic toxicological investigations. Suom Laakaril 54:421–425

    Google Scholar 

  18. Vuori E, Ojanperä I, Ojansivu RL, Nieminen R (1999) Drug, poison, drug of abuse, or alcohol again? Duodecim 115:1531–1535

    Google Scholar 

  19. Vuori E, Ojanperä I, Nokua J, Ojansivu RL (2001) Fatal poisonings in Finland during 1998 and 1999 based on forensic toxicological investigations. Suom Laakaril 56:2521–2525

    Google Scholar 

  20. Vuori E, Ojanperä I, Nokua J, Ojansivu RL (2003) Fatal poisonings in Finland during 2000 and 2001 based on forensic toxicological investigations. Suom Laakaril 58:3403–3407

    Google Scholar 

  21. Jones AW, Schuberth J (1989) Computer-aided headspace gas chromatography applied to blood-alcohol analysis: importance of online process control. J Forensic Sci 34:1116–1127

    Google Scholar 

  22. Rasanen I, Ojanperä I, Vuori E (2000) Quantitative screening for benzodiazepines in blood by dual-column gas chromatography and comparison of the results with urine immunoassay. J Anal Toxicol 24:46–53

    Google Scholar 

  23. Koski A, Ojanperä I, Vuori E (2002) Alcohol and benzodiazepines in fatal poisonings. Alcohol Clin Exp Res 26:956–959

    Google Scholar 

  24. Worm K, Dragsholt C, Simonsen K, Kringsholm B (1998) Citalopram concentrations in samples from autopsies and living persons. Int J Leg Med 111:188–190

    Google Scholar 

  25. Kelly CA, Dhaun N, Laing WJ, Strachan FE, Good AM, Bateman DN (2004) Comparative toxicity of citalopram and the newer antidepressants after overdose. J Toxicol Clin Toxicol 42:67–71

    Google Scholar 

  26. Egberts AC, Lenderink AW, de Koning FH, Leufkens HG (1997) Channeling of three newly introduced antidepressants to patients not responding satisfactorily to previous treatment. J Clin Psychopharmacol 17:149–155

    Google Scholar 

  27. Heerdink ER, Hugenholtz GW, Meijer WE, Egberts AC (2003) Channelling new antidepressants to problem patients may be factor in fatal toxicity. Br Med J 325:600

    Google Scholar 

  28. Preskorn SH (1997) Clinically relevant pharmacology of selective serotonin reuptake inhibitors. An overview with emphasis on pharmacokinetics and effects on oxidative drug metabolism. Clin Pharmacokinet 32(Suppl 1):1–21

    Google Scholar 

  29. Bateman DN, Chick J, Good AM, Kelly CA, Masterton G (2004) Are selective serotonin re-uptake inhibitors associated with an increased risk of self-harm by antidepressant overdose? Eur J Clin Pharmacol 60:221–224

    Google Scholar 

  30. Bentur Y, Raikhlin-Eisenkraft B, Lavee M (2004) Toxicological features of deliberate self-poisonings. Human Exp Toxicol 23:331–337

    Google Scholar 

Download references

Acknowledgements

This study was supported by a grant from the Finnish Foundation for Alcohol Studies.

Author information

Authors and Affiliations

  1. Laboratory of Toxicology, Department of Forensic Medicine, P.O. Box 40, 00014, University of Helsinki, Finland

    Anna Koski, Erkki Vuori & Ilkka Ojanperä

Authors
  1. Anna Koski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erkki Vuori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ilkka Ojanperä
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anna Koski.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Koski, A., Vuori, E. & Ojanperä, I. Newer antidepressants: evaluation of fatal toxicity index and interaction with alcohol based on Finnish postmortem data. Int J Legal Med 119, 344–348 (2005). https://doi.org/10.1007/s00414-005-0528-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-005-0528-x

Keywords

Search

Navigation