Deaths from antidepressants in England and Wales 1993-1997: analysis of a new national database

Background. The prescription of antidepressants has increased substantially over the last 10 years. It is therefore timely to examine trends in mortal ity associated with overdoses of antidepressants and to compare the relativ e mortality associated with different antidepressants. Methods. Data were derived from a newly developed national database of deat hs from overdose and poisoning in England and Wales between 1993 and 1997. Age and sex specific death rates associated with overdose and poisoning wit h antidepressants were calculated together with numbers of deaths per 10000 0 prescriptions of individual antidepressants. Results. Twenty per cent (2503) of all deaths from overdose or poisoning we re antidepressant related. The number of deaths increased by 18% between 19 93 and 1997. Ninety-five per cent of deaths from antidepressants were assoc iated with tricyclic antidepressants, particularly dothiepin and amitriptyl ine. Tricyclic antidepressants were associated with 5.3 deaths per 100000 p rescriptions, 4.4 for monoamine oxidase inhibitors and 0.4 for selective se rotonin reuptake inhibitors. Annual death rates were highest in men aged 30 -44 years (18.2 per million) and women aged 45-59 years (14.8). Death rates from antidepressants were 2.5 times higher in the most deprived fifth than in the least deprived fifth of enumeration districts. Conclusions. Antidepressants are an important cause of death from poisoning and overdose. SSRIs and newer antidepressants are associated with < 10% of the risk of death than the older antidepressants. There is a strong associ ation between area deprivation and deaths from antidepressants.