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Published Date: 31 January 2017

Morbidity and Mortality Associated With Medications Used in the Treatment of Depression: An Analysis of Cases Reported to U.S. Poison Control Centers, 2000–2014

J. Craig Nelson, M.D., and Daniel A. Spyker, Ph.D., M.D.Authors Info & Affiliations
Publication: American Journal of Psychiatry
Volume 174, Number 5
https://doi.org/10.1176/appi.ajp.2016.16050523
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Abstract

Objective:

The authors sought to determine the relative morbidity and mortality associated with drugs used to treat depression and to examine specific clinical effects associated with serious outcomes.

Method:

The National Poison Data System, which receives exposure reports from regional poison centers serving the United States, Puerto Rico, and the District of Columbia, was queried for single drug exposures in individuals 12 years and older during the period 2000–2014. Medications included were antidepressants, atypical antipsychotics, anticonvulsants, lithium, and other medications used in the treatment of depression. The main outcomes were the morbidity index (the number of serious outcomes per 1,000 exposures) and the mortality index (the number of fatal outcomes per 10,000 exposures).

Results:

During this 15-year period, there were 962,222 single substance exposures to the 48 medications studied. Serious outcomes rose 2.26-fold and in linear fashion over the 15 years. While tricyclic and monoamine oxidase inhibitor medications were associated with high morbidity and mortality, several newer agents also appeared hazardous. Lithium, quetiapine, olanzapine, bupropion, and carbamazepine were associated with high morbidity indices. Lithium, venlafaxine, bupropion, quetiapine, olanzapine, ziprasidone, valproic acid, carbamazepine, and citalopram were associated with higher mortality indices.

Conclusions:

Serious outcomes after overdose or nonintentional exposures to medications used to treat depression have risen dramatically over the past 15 years. The present data suggest that the morbidity and mortality risks vary substantially among these medications. These differences become important when selecting treatments for patients with depression, especially those at increased risk for suicide.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Volume 174 • Number 5 • May 01, 2017
Pages: 438 - 450
PubMed: 28135844

History

Received: 5 May 2016
Revision received: 26 August 2016
Accepted: 20 October 2016
Published online: 31 January 2017
Published in print: May 01, 2017

Keywords

  1. Antidepressants
  2. Antipsychotics
  3. Mood Disorders-Unipolar
  4. Mood Disorders-Bipolar
  5. Overdose

Authors

Details

J. Craig Nelson, M.D.
From the Department of Psychiatry, University of California, San Francisco; and the Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, Ore.
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Daniel A. Spyker, Ph.D., M.D.
From the Department of Psychiatry, University of California, San Francisco; and the Department of Physiology and Pharmacology, Oregon Health and Science University, Portland, Ore.
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Notes

Address correspondence to Dr. Nelson ([email protected]).
Presented in part at the annual congress of the European Association of Poisons Centres and Clinical Toxicologists, Malta, May 27, 2015, and at the annual meeting of the American Society of Clinical Psychopharmacology, Miami, June 23, 2015.

Funding Information

Dr. Nelson is supported in part by the University of California, San Francisco, Leon J. Epstein Fund.During the past 3 years, Dr. Nelson has received 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. Dr. Spyker has been a full-time employee of, owns stock in, holds stock options in, and serves as a consultant to Alexza Pharmaceuticals, the developer and manufacturer of inhaled loxapine.

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