Trends in antidepressant overdoses

Pharmacoepidemiol Drug Saf. 2007 May;16(5):513-23. doi: 10.1002/pds.1355.

Abstract

Background: Debate continues about antidepressants and suicide. However, there are few recent nation-wide data about antidepressant overdoses. The purpose of this study was to describe United States trends from 1983 through 2003 in antidepressant overdoses as well as trends in health care utilization and mortality.

Methods: Data were obtained from the American Association of Poison Control Centers' (AAPPC) Toxic Exposure Surveillance System (TESS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) of emergency departments, and the National Hospital Discharge Survey(NHDS).

Results: Antidepressant overdose reports rose dramatically in the United States (from 0.61 per 10,000 population in 1983 to 3.26 per 10,000 population in 2003) chiefly due to the rise in selective serotonin reuptake inhibitor (SSRI) ingestion. However, fatalities per antidepressant overdose report declined from 73 per 10,000 reported ingestions to 32 per 10,000 ingestions. Tricyclic antidepressant (TCA) overdoses had higher rates of hospitalization (78.7 vs. 64.7% hospitalized) and much higher fatality rates than did SSRI overdose reports (0.73 vs. 0.14% mortality). If the 55,977 SSRI overdoses in 2003 had represented TCA overdoses, then (other things being equal) approximately 410 fatalities would have been expected but only 106 people died. Emergency department visits associated with antidepressant overdose increased along with all emergency department visits. Hospitalization associated with antidepressant overdose increased in the early 1980s but then reached a plateau while overall hospitalizations declined.

Conclusions: The dramatic rise in United States antidepressant overdoses has not been reflected in antidepressant overdose fatalities nor in hospitalizations. If the marked increase in antidepressant overdoses in the United States had involved TCAs rather than SSRIs, then there would have been roughly 300 excess deaths annually.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antidepressive Agents, Tricyclic / administration & dosage
  • Antidepressive Agents, Tricyclic / adverse effects*
  • Child
  • Databases, Factual / classification
  • Databases, Factual / statistics & numerical data
  • Delivery of Health Care / methods
  • Delivery of Health Care / statistics & numerical data
  • Delivery of Health Care / trends
  • Drug Overdose / mortality
  • Emergency Service, Hospital / statistics & numerical data
  • Emergency Service, Hospital / trends
  • Hospitalization / statistics & numerical data
  • Hospitalization / trends
  • Humans
  • Odds Ratio
  • Serotonin Uptake Inhibitors / administration & dosage
  • Serotonin Uptake Inhibitors / adverse effects*
  • Survival Rate / trends
  • Time Factors
  • United States / epidemiology

Substances

  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors