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Psychotropics and suicide prevention

Implications from toxicological screening of 5281 suicides in Sweden 1992–1994

Published online by Cambridge University Press:  02 January 2018

Göran Isacsson ,
Per Holmgren ,
Henrik Druid  and
Ulf Bergman
Göran Isacsson*
Affiliation:
Department of Clinical Neuroscience and Family Medicine, Division of Psychiatry, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden
Per Holmgren
Affiliation:
Department of Forensic Chemistry, National Board of Forensic Medicine, Linköping, Sweden
Henrik Druid
Affiliation:
Division of Forensic Medicine, Faculty of Health Sciences, University of Linköping, Sweden
Ulf Bergman
Affiliation:
Department of Medical Laboratory Sciences and Technology, Division of Clinical Pharmacology, and WHO Collaborating Centre on Drug Utilization Research and Clinical Pharmacological Services, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden
*
Göran Isacsson, Huddinge University Hospital, M59, S-141 86 Huddinge, Sweden. Tel: +46-8-585 85764; Fax: +46-8-585 866 30; e-mail [email protected]
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Abstract

Background

Systematic clinical investigations of consecutive suicides have found psychiatric disorders in 90–95% of subjects (depressive disorder 30–87%).

Aims

To investigate use of psychotropics in men and women of different ages who commit suicide.

Method

Results of toxicological screening in 5281 suicides in Sweden 1992–94 were studied.

Results

Psychotropics were detected in 45.3% of the suicides. Antidepressants were detected in 12.4% of the men and 26.2% of the women (7.2% and 14.2%, respectively, of those under 30 years of age). Neuroleptics or antiepileptics (in the absence of antidepressants) were detected in 8.3%, and anxiolytics/hypnotics alone in 20.5% of the subjects. Overdose by an antidepressant was the probable cause of death in 2.1% of the men and 7.9% of the women.

Conclusions

The pattern of psychotropics detected in toxicology was incongruent with the pattern of diagnoses found in the clinical investigations of suicides mentioned above. Depression appears to be undertreated in individuals committing suicide, especially in men and in subjects under 30 years of age.

Type
Papers
Information
The British Journal of Psychiatry , Volume 174 , Issue 3 , March 1999 , pp. 259 - 265
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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Footnotes

Declaration of interest

Financial support provided by the Karolinska Institute, the Swedish Society of Medicine, the Söderström–König Foundation and the Bror Gadelius Memorial Foundation.

References

Armtó, M., Demeter, E., Rihmer, Z., et al (1988) Retrospective psychiatric assessment of 200 suicides in Budapest. Acta Psychiatrica Scandinavica, 77, 454–456.Google Scholar
Åsgård, U. (1990) A psychiatric study of suicide among urban Swedish women. Acta Psychiatrica Scandinavica, 82, 115–124.Google Scholar
Berraclough, B. M. (1987) The suicide rate in epilepsy. Acta Psychiatrica Scandinavica, 76, 339–345.Google Scholar
Berraclough, B. M., Bunch, J., Nekton, B., et al (1974) A hundred cases of suicide: clinical aspects. British Journal of Psychiatry, 125, 355–373.Google Scholar
Baselt, R. C. & Cravey, R. H. (1995) Disposition of Toxic Drugs and Chemicals in Man (4th edn). Foster City: Chemical Toxicological Institute.Google Scholar
Bergman, U. & Myrhed, M. (1993) Benzodiazepine use in Sweden. Lancet, 342, 373–374.Google Scholar
Beskow, J. (1979) Suicide and mental disorder in Swedish men 1970–71. Acta Psychiatrica Scandinavica, (suppl. 277), 1–138.Google Scholar
Cheng, A. T. A. (1995) Mental illness and suicide. Archives of General Psychiatry, 52, 594–603.CrossRefGoogle ScholarPubMed
Chynoweth, R., Tonge, J. I. & Armstrong, J. (1980) Suicide in Brisbane: a retrospective psychosocial study. Australian and New Zealand Journal of Psychiatry, 14, 37–45.CrossRefGoogle ScholarPubMed
Dorpat, T. L. & Ripley, H. S. (1960) A study of suicide in the Seattle area. Comprehensive Psychiatry. 1, 349–359.CrossRefGoogle ScholarPubMed
Druid, H., Holmgren, P. & Lowenhielm, P. (1996) Computer-assisted systems for forensic pathology and forensic toxicology. Journal of forensic Sciences, 41, 830–836.Google Scholar
Druid, H., Holmgren, P. & Lowenhielm, P. (1997) A compilation of fatal and control concentrations of drugs in postmortem femoral blood. Journal of forensic Sciences, 42, 79–87.Google Scholar
Foster, T., Gillespie, K. & McClelland, R. (1997) Mental disorders and suicide in Northern Ireland. British Journal of Psychiatry, 170, 447–452.Google Scholar
Hagnell, O., Öjesjö, L., Otterbeck, L., et al (1993) Prevalence of mental disorders, personality traits and mental complaints in the Lundby Study. Scandinavian Journal of Social Medicine Supplement, (suppl. 50), 1–76.Google Scholar
Isacsson, G., Boëthius, G. & Bergman, U. (1992) Low level of antidepressant prescription for people who later commit suicide: 15 years of experience from a population-based drug database in Sweden. Acta Psychiatrica Scandinavica, 85, 444–448.CrossRefGoogle ScholarPubMed
Isacsson, G., Bergman, U. & Rich, C. L. (1994) Antidepressants, depression, and suicide: an analysis of the San Diego Study. Journal of Affective Disorders, 32, 277–286.CrossRefGoogle ScholarPubMed
Isacsson, G., Wasserman, D. & Bergman, U. (1995) Self-poisonings with antidepressants and other psychotropics in an urban area of Sweden. Annals of Clinical Psychiatry, 7, 113–118.CrossRefGoogle Scholar
Isacsson, G., Bergman, U. & Rich, C. L. (1996) Epidemiological data suggest antidepressants reduce suicide risk among depressives. Journal of Affective Disorders, 41, 1–8.Google Scholar
Isacsson, G., Holmgren, P., Druid, H., et al (1997) The utilization of antidepressants - a key issue in the prevention of suicide. An analysis of 5.281 suicides in Sweden 1992–94. Acta Psychiatrica Scandinavica, 96, 94–100.Google Scholar
Isacsson, G., Boëthius, G., Henriksson, S., et al (1999) SSRIs have broadened the utilisation of antidepressants in accordance with recommendations. Findings from a Swedish prescription database. Journal of Affective Disorders, in press.Google Scholar
Jick, S. S., Dean, A. D. & Jick, H. (1995) Antidepressants and suicide. British Medical Journal, 310, 215–218.Google Scholar
Kelleher, M. J., Daly, M. & Kalleher, M. J. A. (1992) The influence of antidepressants in overdose on the increased suicide rate in Ireland between 1971 and 1988. British Journal of Psychiatry, 161, 625–628.CrossRefGoogle ScholarPubMed
Marzuk, P. M., Tardiff, K., Leon, A. C., et al (1995) Use of prescription psychotropic drugs among suicide victims in New York City. American Journal of Psychiatry, 152, 1520–1522.Google Scholar
Ohberg, A., Vuori, E., Ojanperä, I., et al (1996) Alcohol and drugs in suicides. British Journal of Psychiatry, 169, 75–80.Google Scholar
Rich, C. L., Young, D. & Fowier, R. C. (1986) The San Diego suicide study: I. Young vs old subjects. Archives of General Psychiatry, 43, 577–582.CrossRefGoogle Scholar
Rich, C. L., Ricketts, J. E., Fowier, R. C., et al (1988) Some differences between men and women who commit suicide. American Journal of Psychiatry, 145, 718–722.Google Scholar
Rich, C. L. & Isacsson, G. (1997) Suicide and antidepressants in South Alabama: evidence for improved treatment of depression. Journal of Affective Disorders, 45, 135–142.Google Scholar
Robins, C. L., Murphy, G. E., Wilkinson, R. H., et al (1959) Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. American Journal of Public Health, 49, 888–899.Google Scholar
Runeson, B. (1989) Mental disorder in youth suicide. Acta Psychiatrica Scandinavica, 79, 490–497.CrossRefGoogle ScholarPubMed
Rutz, W., von Knorring, L., Pihlgren, H., et al (1995) An educational project on depression and its consequences: is the frequency of major depression among Swedish men underrated, resulting in high suicidally? Primary Care Psychiatry, 1, 59–63.Google Scholar
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