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Overdose, adverse exposure to depression medications increase in US

Analysis of cases reported to Poison Control indicated overdose or unintentional adverse exposure to depression medications significantly increased from 2000 to 2014.

“From 2000 through 2014, the suicide rate increased by 25% (from 10.4 to 13 deaths per 100,000 persons), and the number of suicides from poisoning increased by 38.5%. Most (89% to 92%) of the poisoning deaths involved medications,” J. Craig Nelson, MD, of the University of California, San Francisco, and Daniel A. Spyker, PhD, MD, of Oregon Health and Science University, Portland, wrote. “Depressive disorders (eg, major depression, dysthymia, and bipolar depression) are significant risk factors for suicide. Unfortunately, the same medications that are given to patients to treat depression can become the vehicle for a serious suicide attempt.”

To determine relative morbidity and mortality associated with depression medications, researchers analyzed data from the National Poison Data System for single drug exposures among individuals aged 12 years and older from 2000 to 2014. Medications included antidepressants, atypical antipsychotics, anticonvulsants, lithium, and other medications used for depression.

Overall, there were 962,222 single substance exposures to the 48 included medications.

During the 15-year study period, there was a 2.26-fold linear increase in serious outcomes.

Tricyclic and monoamine oxidase inhibitor medications were associated with high morbidity and mortality.

Lithium, quetiapine, olanzapine, bupropion and carbamazepine were associated with high morbidity indexes.

Further, lithium, venlafaxine, bupropion, quetiapine, olanzapine, ziprasidone, valproic acid, carbamazepine and citalopram were associated with higher mortality indexes.

“Although the risk that an individual depressed patient will overdose and have a serious outcome is quite low, the public health risk is significant given the rising rates of suicide attempts with medications used in depression,” the researchers wrote. “In addition, these risks are likely to be magnified in patients with exposure to multiple medications, especially when the other agents have similar clinical effects, such as delayed cardiac conduction, seizures, and respiratory depression. As a consequence, differences among these medications become important. For drugs with similar efficacy and similar mechanisms of action, morbidity and mortality risk following overdose should be an important consideration in drug selection.” – by Amanda Oldt

Disclosure: Nelson reports receiving consultation or advisory fees from Bristol-Myers Squibb, Corcept, Eli Lilly, Genentech, Janssen, Lundbeck, Otsuka, Shire, and Sunovion; lecture honoraria from Bristol- Myers Squibb, Genentech, Lundbeck, and Otsuka; research support from Avid and NIMH; and royalties from UpToDate. Please see the study for a full list of relevant financial disclosures.