FLUOXETINE AND VIOLENT DEATH IN MARYLAND

A retrospective Medical Examiner case review of all deaths in Maryland where either fluoxetine or tricyclic antidepressant (TCA) use was for ensically detected was conducted for the time period January 1987-July 1991. Case records and toxicology reports from the Office of the Chie f Medical Examiner were reviewed to determine cause and manner of deat h, circumstances of death, demographic information on the decedent, pr ior medical history of the decedent, and presence and level of either fluoxetine or TCA in various body fluids/tissues. Suicide was the mann er of death most frequently associated with TCA and fluoxetine detecti on. Violent methods were more often associated with fluoxetine suicide s than with TCA suicides (65% v. 23%, P < 0.001). Demographic characte ristics of antidepressant-related deaths in Maryland were similar to t hose of the entire USA. Possible explanations for the results obtained include the inherent lower lethality of fluoxetine compared to the TC As, necessitating the use of additional means to complete the act of s uicide; that physicians may have switched more impulsive, high risk pa tients to this new agent as it became available, thus creating a selec tion bias for more violence-prone individuals in the fluoxetine group; or that fluoxetine may be associated with induction of violence and/o r suicidal ideation. Further research examining the possible associati on of these agents with violent acts is warranted.