Fatality caused by a combined trimipramine-citalopram intoxication

A 53-year-old woman who was diagnosed as suffering from depression was foun d dead in her bed. The autopsy revealed no morphological changes sufficient to explain death. Toxicological analysis was performed and the drugs trimi pramine (2.33 mg/l), citalopram (4.81 mg/l) and zolpidem (0.07 mg/l) were i dentified in the femoral blood. A combined drug intoxication resulting in s ynergistic effects to cardiovascular disorders was proposed as the cause of death. An acute overdose and suicide was suggested by calculation of the p arent drug to main metabolite ratios in femoral blood and liver tissue. The trimipramine to desmethyltrimipramine ratios were calculated to be 2.06 an d 3.18, the citalopram to desmethylcitalopram ratios were 1.96 and 2.02. (C ) 1999 Elsevier Science Ireland Ltd. All rights reserved.