Transcript No Slide Title

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
Numbers of deaths
600
500
400
Other
antidepressants
Amitriptyline
300
200
Dothiepin
100
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
0
Year of death
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Deaths per million population
Antidepressant-related age-specific death
rates, England & Wales, 1993 to 2000
20
18
16
14
12
10
8
6
4
2
0
Male
Female
0-14
15-29
30-44
45-59
60-74 75 and
All
over
ages
Age group
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Antidepressant-related deaths, by BNF
category, England & Wales, 1993 to 2000
8
Type of antidepressant
deaths
%
All antidepressants
Tricyclics and related
Monoamine-oxidase inhibitors
Selective serotonin re-uptake
Inhibitors
3,959
3,637
47
100
92
1
259
7
Prescriptions issued by general
practitioners, England, 1993 to 2000
14
12
Millions
10
Tricyclics
MAOIs
SSRIs & others
8
6
4
2
0
1993 1994 1995 1996 1997 1998 1999 2000
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Year
Antidepressant-related deaths per 100,000
prescriptions, England 1993 to 2000
6.0
5.0
Rate
4.0
Tricyclics
SSRIs and others
3.0
2.0
1.0
0.0
1993 1994 1995 1996 1997 1998 1999 2000
Year
10
Antidepressant-related deaths per 100,000
prescriptions, England 1993 to 2000
Tricyclic and related antidepressants
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Rate
Amitriptyline
Dothiepin
Lofepramine
5.1
6.8
0.5
SSRIs and other antidepressants
Fluoxetine
Paroxetine
Venlafaxine
Rate
0.4
0.3
1.7
Annual antidepressant related deaths per million
population by deprivation score of enumeration
districts in England and Wales 1993-1997
Death rates per million
12
10
8
6
4
2
0
1
2
3
4
Deprivation group of enumeration district
(1=least deprived, 5=most deprived)
12
5
Antidepressant-related deaths by BNF
category, substances taken alone or with
other drugs, England & Wales, 1993 to 2000
he
rs
Is
O
an
d
ot
M
A
SS
R
Is
id
ep
re
ss
an
an
t
ll
A
13
Tr
ic
yc
l ic
s
Alone
With other drug
ts
Per cent
80
70
60
50
40
30
20
10
0
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 drugrelated 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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Contacts
[email protected]
www.statistics.gov.uk
[email protected]
www.azmaj.org
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