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

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.

Antidepressant and antipsychotic medication errors reported to United States poison control centers

“…Unintentional therapeutic errors associated with antidepressants and antipsychotics represent a national public health burden, resulting in an average of 15 975 exposures reported to PCCs annually or approximately 1 every 33 minutes. The frequency and rate of these medication errors increased significantly from 2000 to 2012, a trend consistent with previous research . This trend may reflect an increase in clinical diagnoses and treatment of psychiatric disorders, greater availability and variety of psychotropic medications, or expanded indications for pharmacological management of psychiatric conditions .…”

“…Given the widespread and increasing use of antidepressant and antipsychotic medications in non‐HCF settings, as well as their known links to medication errors, additional research is warranted on this topic. Multiple studies have included the major drug categories of antidepressants and antipsychotics as elements of a general investigation examining medication errors; others have studied intentional exposures associated with these drugs . This study examines non‐HCF unintentional therapeutic errors associated with specific subcategories of antidepressant and antipsychotic medications, expanding the breadth of the American Association of Poison Control Centers' (AAPCC) annual report to include detailed characterization of these errors as well as multiyear trend information.…”

“…Multiple studies have included the major drug categories of antidepressants and antipsychotics as elements of a general investigation examining medication errors; others have studied intentional exposures associated with these drugs. 2,4,6,8,11,12 This study examines non-HCF unintentional therapeutic errors associated with specific subcategories of antidepressant and antipsychotic medications, expanding the breadth of the American Association of Poison Control Centers' (AAPCC) annual report to include detailed characterization of these errors as well as multiyear trend information. Focusing specifically on unintentional medication errors occurring in non-HCF settings, rather than all exposures, may yield important information for guiding future prevention efforts.…”

Substances Involved in Suicidal Poisonings in the United States

“…One of the goals of the National Strategy for Suicide Prevention is to reduce access to lethal means of suicide (Office of the Surgeon General, National Action Alliance for Suicide Prevention, ). One method, related to prescription medications, has been to prescribe members within a class that have less toxicity (Hawton et al., ; Nelson & Spyker, ; White et al., ). But this may not always be possible.…”

“…Moreover, the medication classes reported are often broad and group several pharmacologic classes together (e.g., “analgesic” may include acetaminophen, nonsteroidal anti‐inflammatories, salicylates, and opioids). Other studies have focused on classes of medications that may be more likely available to an individual contemplating suicide such as tricyclic antidepressants (TCAs), serotonin‐selective reuptake inhibitors (SSRIs), and atypical antipsychotics (Hawton et al., ; Nelson & Spyker, ; White, Litovitz, & Clancy, ). But this approach selects for individuals who are already under psychiatric care and overdose on their prescription medications, and thus would not be representative of a broader population that includes individuals with no history of psychiatric treatment presenting on the first attempt, often using over‐the‐counter (OTC) medications.…”