A comprehensive analysis of attempted and fatal suicide cases involving frequently used psychotropic medications

Pfeifer, Philippe; Greusing, S.; Kupferschmidt, H.; Bartsch, C.; Reisch, T. (2019). A comprehensive analysis of attempted and fatal suicide cases involving frequently used psychotropic medications. General hospital psychiatry, 63, pp. 16-20. Elsevier 10.1016/j.genhosppsych.2019.07.011

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Objectives: Self-poisoning is the most common suicide method in non-lethal suicide attempts and the third most frequent in fatal suicides. Psychoactive drugs are
often used for intentional self-poisoning. While poisons centre data typically focus on survived suicide attempts and underrepresent fatal self-poisoning, medical
examiner reports give insight into suicide deaths. To close this gap, we combined and compared data sets from both sources, assessing the mortality of psychotropic
drugs used for self-poisoning.
Methods: Anonymized cases of self-poisoning with suicidal intention from 2000 to 2010 were extracted from the national poisons centre case database and compared
with cases of suicide documented in the project “Suicides, a national survey”. All cases with single substance exposure to a psychoactive drug (antidepressants, mood
stabilizers, antipsychotics, sedatives) were included in the analyses. Opioids, over-the-counter- and illicit- drugs were excluded from the analysis. A mortality index
was calculated by the ratio of the number of suicides and the sum of all (lethal and non-lethal) suicide attempts.
Results: Tricyclics had a higher mortality rate than other antidepressants. Among the sedatives, zolpidem was found to have a higher mortality index compared to
benzodiazepines. Clozapine and levomepromazine were found to be the most lethal antipsychotics. Non-lethal suicide cases with single substance exposure
(n=4697) diminished as age increased, while the rate of suicide cases (n=165) was higher in elderly subjects (> 65 years of age, p < 0.001).
Conclusion: In summary, our findings confirm previous study results on the relative toxicity of distinct classes of psychotropic drugs. In this comprehensive analysis of
a national cohort lorazepam had a lower mortality rate compared to other sedatives.

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