Transcript No Slide Title
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Deaths from antidepressants in England and Wales 1993 to 2000: analysis of a national database of drug-related poisoning deaths
Allan Baker, UK Office for National Statistics Zoe Uren, UK Office for National Statistics Clare Griffiths, UK Office for National Statistics Raj Shah, Sutton Hospital, London, UK Azeem Majeed, University College London, UK
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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.
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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.
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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
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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 these suicides
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Trends in antidepressant-related deaths, England & Wales, 1993 to 2000 600 500 400 300 200 100 0 1993 1994 1995 1996 1997 1998 Year of death 1999 2000 Other antidepressants Amitriptyline Dothiepin
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Antidepressant-related age-specific death rates, England & Wales, 1993 to 2000 8 6 4 2 0 20 18 16 14 12 10 Male Female 0-14 15-29 30-44 45-59 Age group 60-74 75 and over All ages
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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
Prescriptions issued by general practitioners, England, 1993 to 2000
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14 12 10 8 2 0 6 4 1993 1994 1995 1996 1997 1998 1999 2000 Year Tricyclics MAOIs SSRIs & others
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Antidepressant-related deaths per 100,000 prescriptions, England 1993 to 2000 6.0
5.0
4.0
3.0
Tricyclics SSRIs and others 2.0
1.0
0.0
1993 1994 1995 1996 1997 1998 1999 2000 Year
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
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SSRIs and other antidepressants
Fluoxetine Paroxetine Venlafaxine
Rate
0.4
0.3
1.7
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Annual antidepressant related deaths per million population by deprivation score of enumeration districts in England and Wales 1993-1997
2 0 6 4 12 10 8 1 2 3 4
Deprivation group of enumeration district (1=least deprived, 5=most deprived)
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Antidepressant-related deaths by BNF category, substances taken alone or with other drugs, England & Wales, 1993 to 2000 80 70 60 50 40 30 20 10 0 Alone With other drug All a nt id ep re ss an ts Tr ic yc lic s M AO SS Is RIs a nd o th er s
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Monthly treatment costs (US $)
$3 Amitriptyline (75mg daily) $6 Dothiepin (75mg daily) $24 Fluoxetine (20mg daily)
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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.
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