ABSTRACT
OBJECTIVE: This study examined the predictors, extent and pattern of fatal antidepressant overdose (FAO) in all psychoactive drug-related deaths and compared these in drug abusers and non-drug abusers. METHOD: Inquest data on 491 psychoactive drug-related cases in England and Wales were analysed. We examined predictors of FAO relative to other drug-related deaths in drug abusers and non-abusers using logistic regression, and compared the relative fatality of different antidepressant classes using the Proportionate Fatality Index (PFI). RESULTS: The overall FAO prevalence ratio was 10% (male = 7.1%, female = 18.5%). FAO was twice as likely to occur among cases aged 45 years and over than in younger cases (MOR = 2.6, 95% CI = 1.4-4.9), and eight times more likely to occur in cases with no history of drug abuse (MOR = 8.2, 95% CI = 4.0-18.4). Ingestion of prescribed antidepressants is the only common predictor of FAO among drug abusers and non-abusers, and co-ingestion of a combination of antidepressants of two different classes is a potent risk for FAO in the cases studied. CONCLUSION: The results highlight the need to develop appropriate therapeutic strategies for managing treatment-resistant depression.
Subject(s)
Antidepressive Agents/adverse effects , Substance-Related Disorders/diagnosis , Adult , Antidepressive Agents/administration & dosage , Depression/drug therapy , Dose-Response Relationship, Drug , Drug Overdose , Female , Humans , MaleABSTRACT
This paper examines the methadone-related deaths (MRD) among entire cases of inquest on drug-related cases in 18 coroners' jurisdictions in England which were entered on the National Programme on Substance Abuse Deaths during a six-month period in 1997. In 154 deaths methadone, either prescribed or not prescribed, was reported to be the substance directly implicated in the death of 40 individuals. The MRD between the prescribed and non-prescribed cases were compared in respect to various demographic variables and associated risks. The main findings reported are that the majority of deaths in this sample were in cases where methadone had not been prescribed (72%) and that there was a significant difference in age between the methadone prescribed (median = 22 years) and non-prescribed groups (median = 37 years) (Mann-Whitney U = 57.5, p = 0.01). Also significant differences amongst the two groups in respect of the coroners' verdicts are reported. The authors suggest more stringent controls around the prescription and dispensing of methadone, along with measures to alert the population at risk of the hazards of using methadone in a non-controlled fashion.
Subject(s)
Methadone/poisoning , Adult , Coroners and Medical Examiners , Drug Prescriptions , England/epidemiology , Female , Humans , Male , Middle Aged , Poisoning/mortalitySubject(s)
Anti-Allergic Agents/therapeutic use , Fluoxetine/adverse effects , Selective Serotonin Reuptake Inhibitors/adverse effects , Sexual Dysfunction, Physiological/chemically induced , Sexual Dysfunction, Physiological/drug therapy , Terfenadine/therapeutic use , Drug Therapy, Combination , Humans , MaleABSTRACT
OBJECTIVE: This report describes the rare combination of anorexia nervosa, deafness, and visual impairment with a particular emphasis on management issues. To the author's knowledge, this is the first report of an eating disorder in a patient who is deaf with a visual impairment. DISCUSSION: It describes the history of such a patient and the difficulties encountered in her treatment.
