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[Deaths caused by antidepressive agents and neuroleptics. Risk groups illustrated by a forensic material].

At the Institute of Forensic Medicine, University of Oslo, legal autopsy was performed on 153 persons who died from poisoning by neuroleptics and/or antidepressants from 1986 to 1989. In one third of the cases, only neuroleptics were found at autopsy, and in little less than half of these cases the post mortem blood concentrations were considered rather low in relation to the fatal outcome. A larger proportion of alcohol abusers were found in the group with low post mortem concentrations of neuroleptics than in the rest of the material. This group contained mainly men and was further characterized by a high proportion of unintentional deaths. In the light of these facts the authors speculate whether neuroleptics represent increased risk of sudden death among alcohol abusers. The deaths due to an overdose of antidepressants were mostly suicides, and involved high post mortem blood concentrations of the drugs.

Adolescent↗

[Compliance, subdosage and overdosage of antidepressive agents in the first prescription in a hospital milieu].

It is common clinical experience that depressed patients comply poorly with their treatment schedules. In a retrospective study, the authors studied the compliance with the tricyclic antidepressant treatment (TCA) in 1,023 in-patients and evaluated the frequency of the plasma levels under or above the therapeutic range, following a first prescription of TCA. To describe the adherence to the TCA regimen, the investigators have classified patients as either "compliant" or "bad compliant" on the basis of two different arbitrary dividing points: plasma levels of tertiary OR secondary amine lower than 20 ng/ml, or plasma levels of tertiary AND secondary amine lower than 20 ng/ml. The antidepressant plasma levels were measured, on steady state conditions, using a gas chromatographic method. The incidence of bad compliance ranged between about 2.5 and 10%, depending on the criteria used, the incidence of plasma levels under or above the therapeutic window ranged respectively between 26 and 54%-4 and 24%. The results from this study should encourage TCA plasma level measurements.

Antidepressive Agents↗

Combined intoxication with a tricyclic antidepressive agent and a neuroleptic.

We report the case of a patient who co-ingested a tricyclic antidepressant (2500 mg of doxepin) and a neuroleptic drug (3500 mg of prothipendyl). Following overdose either agent can affect the central nervous and cardiovascular systems, inducing arrhythmias, conduction disturbances and hypotension. The presented case illustrates that a combined overdose of tricyclic antidepressants and neuroleptics enhances the possible toxic effects of each drug and especially the risk for adverse cardiac events. The clinical features and management of this combined intoxication are discussed. Treatment with sodium bicarbonate readily corrected a potentially life-threatening cardiac arrhythmia and is therefore suggested to be imperative in the treatment of these cases.

Adult↗

[Electroshocks, antidepressive agents, and anesthesia].

During 12 years, we have effected 6,982 electroshocks with anesthesia and celocurine (N.D.) on 713 patients, i.e. 7.25% of the total hospitalized patients. 62% of them (440) were all this time under antidepressant drugs and 38% (273) were not. We observed 16 minor incidents ten (2.27%) among those under treatment and six (2.19%) among the others; of these 16 incidents, 11 led to an interruption of the treatment for safety. The association of antidepressant drugs with electroshock under anesthesia and celocurine (N.D.) does not present any real danger.

Adolescent↗

Dimensions of response to antidepressant agents in bulimia nervosa: a review.

Many patients suffering from bulimia nervosa benefit from treatment with antidepressant medication. Nurses, like other mental health clinicians, tend to assess the effectiveness of a pharmacologic agent in patients with bulimia nervosa by the decline in the frequency of binge eating episodes. Clinical descriptions and research reports suggest the possibility of additional behavioral dimensions of treatment responsiveness, although the extent to which associated behaviors or symptoms improve is not well documented. This paper examines 16 placebo-controlled pharmacological trials in patients with bulimia nervosa to evaluate a range of potential measures of response to antidepressant intervention.

Adolescent↗