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Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 23–30 | Cite as

Toxicological findings in suicides – frequency of antidepressant and antipsychotic substances

  • Maximilian MethlingEmail author
  • Franziska Krumbiegel
  • Sven Hartwig
  • Maria K. Parr
  • Michael Tsokos
Original Article

Abstract

The role of psychoactive substances in the treatment of mental disorders and the risk of suicide are major public health issues. This cross-sectional study examined the prevalence of antidepressants and antipsychotics detected in toxicological screenings in suicides. Cases from the Institute of Legal Medicine of the Charité-University Medicine Berlin were reviewed over a 4-year-period. All cases (n = 477) with positive toxicology for antidepressants and antipsychotics in blood or organ tissue were included. Frequencies of the detected substances in non-suicide cases (n = 212; male n = 177, 55.2%; female n = 95, 52.5%) and suicide cases (n = 235; male n = 149, 63.4%; female n = 86, 36.6%) were examined. Tricyclic antidepressants (48.1%) were found most frequently in suicides, followed by atypical neuroleptics (37.0%), selective serotonin reuptake inhibitors (28.1%), typical neuroleptics (17.4%), tetracyclic antidepressants (16.2%) and other substances (8.9%). Alcohol was detected in 37.2% of suicides. The leading cause of death was drug poisoning (35.6%) followed by polytrauma (26.8%) and death by hanging (18.5%). A mental disorder (depression, schizophrenia, bipolar disorder, suicidality) was known in 22.9% of suicides. The most common location of death was the person’s own house (63.8%) followed by public places (28.1%) and hospitals (8.1%) The five most common substances in the suicide group were doxepin (20%) citalopram (15.3%), mirtazapine (14.9%), quetiapine (13.6%) and amitriptyline (12.3%). Toxicological findings from cross-sectional studies provide insight into how often certain types of antidepressants and antipsychotics are associated with suicide. A complementary approach is valuable for assessing the risk of suicide during medical treatment because the various available approaches (analysis of suicidal behavior/ideation, toxicity of drugs) each have strengths and limitations.

Keywords

Suicide Toxicology Frequency Antidepressants Antipsychotics Prevalence 

Notes

Acknowledgements

The authors would like to thank Ms. Luisa Hohensee and Ms. Jana Panzke for their help in the extraction of the important information from the case files.

Compliance with ethical standards

Conflict of interest

The authors confirm that this study was not sponsored by third parties, especially any pharmaceutical company.

Ethical approval

Formal consent is not required for this type of study.

Informed consent

Not applicable.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Legal Medicine and Forensic SciencesCharité–University Medicine BerlinBerlinGermany
  2. 2.Institute of Pharmacy, Pharmaceutical ChemistryFreie Universität BerlinBerlinGermany

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