摘要:

This article reviews the scope of suicide and attempted suicide as public health problems from an interntional perspective. Socio‐demographic trends are analyzed and explanatory theories for interntional differences proposed.Suicide and attempted suicide can be prevented, but the development and evaluation of effective large‐scale prevention programs is still in its infancy. Inadequacies in current programs across the world has promoted the establishment of national Task Forces on Suicide Prevention in the United States, Canada and The Netherlands, as well as a WHO strategy on suicide prevention. These groups have formulated comprehensive strategies for the prevention of suicide. The main components of these strategies are:‐ Design and implementation of national research programs;‐ The improvement of services;‐ The provision of information and training on suicide prevention to relevant professional groups, organizations and the general public; and‐ Formulation of strategies and techniques to deal with special risk groups.The added recommendations are seen as important steps in translating a comprehensive national plan to prevent suicide into clinical and research programs that can be effectively implemented to prevent these tragedies aroun

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03043.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Age specific death rates for poisoning with different antidepressant drugs, based on mortality statistics and the numbers of prescriptions dispensed, were calculated for England and Wales 1979–1985. There are marked varitions in mortality associated with different drugs; the highest rates are found with amitriptyline and dothiepin whereas the lowest were associated with mianserin and clomipramine. For all drugs considered, the calculated mortality rates for the over 65 year olds, though still substantial, were lower than those in patients under 65 years of age, probably because of a diminished detection rate of poisoning in this older age group. A high proportion of the fatal overdoses implicating amitriptyline and dothiepin involved more than one substance. The rank order of mortality rates from antidepressants was identical in the different age groups.The implications of these findings are discussed. It is concluded that the variations in mortality rates are mostly due to variations in the inherent toxicity of the drugs (particularly their cardiovascular effects) and only in part due to possible differences in compliance. It is suggested that when antidepressant drugs are prescribed, the risk of death from overdose should be taken into account. Tricyclic drugs, particularly amitriptyline, dothiepin, doxepin, trimipramine and maprotiline, should be avoided in patients at risk of suicide, whatever the age of the patien

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03044.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Since depressed patients are liable to attempt suicide by self‐poisoning, fatal poisoning from overdose is an important part of the overall assessment of any antidepressant drug. Because prescription figures for drugs are available in Britain, a Fatal Toxicity Index can be calculated in terms of deaths (from national mortality data) per million National Health Service prescriptions.This was carried out for the years 1975–1984 (Cassidy and Henry 1987), and has since been updated. The older tricyclic antidepressants as a group had a higher Fatal Toxicity Index than the mean for this drugs studied. Monoamine oxidase inhibitors had intermediate toxicity, and newer drugs introduced since 1973 had lower toxicity than the mean figure for all drugs, which was 34.9 deaths per million prescriptions. If drugs are equally effective clinically, serious consideration should be given to prescribing antidepressants with a lower fatal toxicity as a contribution to suicide prevent

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03045.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Data from different analyses of reported deaths from overdose with antidepressants in the U. K. reveal that amitriptyline and dothiepin are the antidepressants most likely to be associated with death from overdose. All widely used tricylic antidepressants (TCAs) except clomipramine and lofepramine appear to be dangerous in overdose, whereas the newer antidepressants such as mianserin, trazodone, viloxazine and the TCA lofepramine appear to be relatively safe. The toxicity of amitriptyline and dothiepin appears to be greater than all antidepressants including other TCAs and it is important to try to understand why. A number of explanations will be considered:1. Dothiepin and amitriptyline may be inherently more toxic than other TCAs.2. Dothiepin and amitriptyline may induce suicide more than other antidepressants. It is assumed that antidepressants are neutral with regard to inducing suicide but this may not be true. There is, for example, evidence that alprazolam and other benzodiazepines induce suicidal behaviour.3. Amitriptyline and dothiepin are often presented in subtherapeutic and ineffective doses and it is possible that increased suicides may result from inadequately treated depression.4. There may be a selective overreporting of deaths with amitriptyline and dothiepin.5. Amitriptyline and prothiaden may be selectively given to the suicide prone on the mistaken assumption that they are safe.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03046.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In Finland the majority of the users of antidepressants are women and old age people. In the 80's the number of fatal poisonings has increased. During the years 1985 ‐ 1987 58% of these poisonings were women who belonged to the younger age group of the users.The older tricyclic drugs are known to be more toxic, at least in overdose, than the newer antidepressants especially when they are compared to mianserin. Of the latter, however, lately more serious side effects have been reported. For this reason the use of the different kinds of antidepressants in Finland had changed: the sales of doxepin and amitriptyline have increased and those of maprotiline and mianserin have decreased.To study the role of antidepressants in sudden and unexpected deaths the fatality ratio (defined as fatalities divided by defined daily doses per 1000 inhabitant/day) was calculated for four most prescribed antidepressants. As to the sales, amitriptyline has to be considered to be the leading antidepressant followed by doxepin, mianserin and maprotiline. As a detection in the forensic toxicological screening the sales related ratios showed that maprotiline was most commonly found followed by doxepin, amitriptyline and mianserin. When an antidepressant was the cause of death the fatality ratio was highest for doxepin (6.4) followed by maprotiline (4.3). amitriptyline (4.0) and mianserin (1). In cases of established suicides the order was the same again.As a conclusion it can be said that when the risks of the use of antidepressants are evaluated the performance of a single drug must be considered as a whole: the side effects and its role and properties in intoxication versus the antidepressant benefits of the drug, since they are prescribed to depressed and hence patients with a tendency to suicid

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03047.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The number of suicides in Norway has doubled during the last two decades, as has also the number of suicides by intoxication. Data are presented which demonstrate that while barbiturates make out a strongly decreasing percentage of the intoxications, the antidepressants make out a definite increasing percentage. The tricyclic antidepressants make out the bulk. There is a strong need for effective antidepressants with less toxicity than the commonly used tricyclic antidepressants.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03048.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Suicide rates may be reduced by decreasing the availability, cultural acceptance or lethality of certain methods of suicide. With these principles in mind fatal overdoses in Brisbane 1979‐ 1987 were surveyed for substances involved. Psychotropic agents, especially barbiturates predominated. Chloral hydrate was far the most commonly implicated single compound. A case is put for curtailing the availabilty of barbiturates and chloral hydrate. This combined with increasing detection of depressed persons may lead to a further rise in overdoses involving antidepressants which as a group require reduction in their lethalit

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03049.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1989.tb03042.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY