Fatal combined intoxication with new antidepressants. Human cases and an experimental study of postmortem moclobemide redistribution

Three cases are presented in which death was caused by suicidal intoxicatio n with moclobemide in combination with a selective serotonin reuptake inhib itor. Both antidepressant drug types are considered to be relatively safe w ith regard to lethal overdose. However, the combination may cause the serot onin syndrome, a condition with a high mortality rate. In one of the cases, there was clinical information consistent with the serotonin syndrome, in the two other cases, there was no information of the clinical course. Postm ortem redistribution of the selective monoamine oxidase inhibitor moclobemi de was investigated in a rat model. Postmortem concentrations in blood from the vena cava and the heart were found to be in good accordance with antem ortem concentrations. Postmortem concentrations in vitreous humour and vari ous tissues were also measured. The apparent volume of distribution was cal culated to be 0.95+/-0.10 l/kg, which is in the same range as that reported in man. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.