Positional Asphyxiation From Paroxetine

Mr. A was a 19-year-old white man with a diagnosis of social phobia and major depression. He was given paroxetine, 10 mg/day, after a suicidal gesture led to a brief hospitalization. Blood work showed a bilirubin level of 1.9 mg/dl, with an upper normal level of 1.2 mg/dl; the rest of the results were within normal limits. His paroxetine dose was later increased to 20 mg/day; this was his only medication. Mr. A showed considerable improvement in his depressive symptoms and some improvement of his anxiety over the next few weeks. After forgetting to take his medication one night, he took it the next morning and took his scheduled dose later in the evening. His mother found him unresponsive on the couch the next morning.

Mr. A was pronounced dead at the scene. An autopsy reported the cause of death to be mechanical/positional asphyxiation probably secondary to paroxetine. A postmortem blood analysis showed paroxetine levels of 400 ng/ml, with caffeine and theobromine as incidental findings. No other drugs of abuse were found. A pill count did not reveal missing medication. His parents reported him to be fairly stable psychiatrically with no suicidal thoughts or intents before his death. In fact, they had noticed that he was doing better than they had seen him for some time. He had seen his psychologist 2 days before and was doing well at that appointment.