Fatal intoxication with antidepressants: a case with many culprits.
Serotonin-specific reuptake inhibitors (SSRIs) are generally considered safe drugs but fatal adverse effects do sometimes occur, often as a consequence of interactions with other serotonin active drugs. Polypharmacy is usually a problem that the elderly encounter, but it can also have dire consequences for young people, especially when an underlying heart condition is present. Thus, failure to diagnose heart disease and the use of contraindicated medications can be a lethal combination, irrespective of age. Here we present a case of a young adult suffering from bipolar disorder who used a combination of two SSRIs (citalopram and fluoxetine) and a monoamine oxidase inhibitor (MAO; moclobemide) with tragic consequences. The deceased also suffered from undiagnosed hypertrophic cardiomyopathy and was carrier of a genotype that may have predisposed him to increased sensitivity to SSRIs. The apparent difficulty in establishing the manner of death in this case is also discussed.
['Goulas|Antonis|A|http://orcid.org/0000-0002-6189-594X', 'Raikos|Nikolaos|N|', 'Krokos|Diamantis|D|', 'Mastrogianni|Orthodoxia|O|', 'Orphanidis|Amvrosios|A|', 'Zisopoulos|Konstantinos|K|', 'Tsepa|Androniki|A|']
D000328:Adult D001714:Bipolar Disorder D002312:Cardiomyopathy, Hypertrophic D015283:Citalopram D005473:Fluoxetine D005838:Genotype D006579:Heterozygote D006801:Humans D008297:Male D000071184:Pharmacogenomic Variants D050486:Serotonin Plasma Membrane Transport Proteins D017367:Serotonin Uptake Inhibitors
Fatal intoxication Citalopram Fluoxetine Moclobemide HTTLPR