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Introduction

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  1. Deaths from antidepressants in England and Wales 1993 to 2000: analysis of a national database of drug-related poisoning deathsAllan Baker, UK Office for National StatisticsZoe Uren, UK Office for National Statistics Clare Griffiths, UK Office for National Statistics Raj Shah, Sutton Hospital, London, UKAzeem Majeed, University College London, UK

  2. Introduction • Antidepressant drugs are the most common treatment of moderate to severe depression. • Depression carries increased risk of suicide. • Antidepressants are commonly mentioned as contributing to deaths from overdose and poisoning. • Ongoing concerns over the level of toxicity of specific antidepressants.

  3. Development of drug-related poisoning database by UK Office for National Statistics • Old method of counting, used until 1992, difficult to interpret and analyse. • 1993 - redevelopment of vital statistics computer systems resulting in cause of death text being available electronically. • 1999 - development of drug-related poisoning database.

  4. Contents of database • All deaths with underlying cause regarded as resulting from drug-related poisoning, England & Wales, 1993 to 2000 • Every mention of a substance named on death certificate or by the coroner • Standardised drug names / British National Formulary codes • Cause of death • Alcohol indicator • Demographic data - age, sex, marital status, occupation, place of usual residence

  5. Drug-related poisoning deaths, England & Wales, 1993 to 2000 21,631 drug-related poisoning deaths 50% of these suicides 3,959 - deaths which mention antidepressants 79% of thesesuicides

  6. Trends in antidepressant-related deaths, England & Wales, 1993 to 2000

  7. Antidepressant-related age-specific death rates, England & Wales, 1993 to 2000

  8. Antidepressant-related deaths, by BNF category, England & Wales, 1993 to 2000 Type of antidepressant deaths % All antidepressants 3,959 100 Tricyclics and related 3,637 92 Monoamine-oxidase inhibitors 47 1 Selective serotonin re-uptake Inhibitors 259 7

  9. Prescriptions issued by general practitioners, England, 1993 to 2000

  10. Antidepressant-related deaths per 100,000 prescriptions, England 1993 to 2000

  11. Antidepressant-related deaths per 100,000 prescriptions, England 1993 to 2000 Tricyclic and related antidepressants Rate Amitriptyline 5.1 Dothiepin 6.8 Lofepramine 0.5 SSRIs and other antidepressants Rate Fluoxetine 0.4 Paroxetine 0.3 Venlafaxine 1.7

  12. Annual antidepressant related deaths per million population by deprivation score of enumeration districts in England and Wales 1993-1997

  13. Antidepressant-related deaths by BNF category, substances taken alone or with other drugs, England & Wales, 1993 to 2000

  14. Monthly treatment costs (US $) $3 Amitriptyline (75mg daily) $6 Dothiepin (75mg daily) $24 Fluoxetine (20mg daily)

  15. Conclusions • The Office for National Statistics database of drug-related poisoning deaths is an important resource facilitating research on this topic. • Antidepressants are an important contributor to death from overdose and poisoning. • Older tricyclic antidepressants appear substantially more toxic than newer antidepressants. • Reducing prescriptions for older antidepressants, particularly to high risk groups, could reduce deaths from antidepressant overdose.

  16. Contacts mortality@ons.gov.uk www.statistics.gov.uk a.majeed@ucl.ac.uk www.azmaj.org

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