Antidepressant-related deaths and antidepressant prescriptions in England and Wales, 1998-2000 - 1.2004 - The British Journal of Psychiatry

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The British Journal of Psychiatry (2004) 184: 41-47

© 2004 The Royal College of Psychiatrists

Antidepressant-related deaths and antidepressant prescriptions in England

and Wales, 1998-2000

SURVJIT CHEETA, PhD

Department of Addictive Behaviour and Psychological Medicine, St 's

Hospital Medical School, London

FABRIZIO SCHIFANO, MD

Department of Addictive Behaviour and Psychological Medicine, St 's

Hospital Medical School, London

ADENEKAN OYEFESO, PhD

Department of Addictive Behaviour and Psychological Medicine, St 's

Hospital Medical School, London

LUCY WEBB, MSc

Department of Addictive Behaviour and Psychological Medicine, St 's

Hospital Medical School, London

A. HAMID GHODSE, DSc

Department of Addictive Behaviour and Psychological Medicine, St 's

Hospital Medical School, London

Correspondence: Survjit Cheeta, Department of Addictive Behaviour and

Psychological Medicine, St 's Hospital Medical School, University of

London, Cranmer Terrace, London SW17 0RE, UK. Tel: 020 8725 2635; fax: 020

8725 2914; e-mail: scheeta@...

Declaration of interest None.

Background:

Deaths from antidepressants continue to account for a substantial

proportion of drug-related deaths.

Aims:

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.

Method:

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 reu

ptake 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 TCAsin SSRI-resistant

patients should be monitored carefully, and patients prescribed

antidepressants should be screened for drug use/misuse.