Overdosing on antidepressants or any other drugs poses health hazards as well as dangers to one’s life. So, can you OD on antidepressants? In 2019, it was reported that around 5,175 people in the United States died due to antidepressant overdose. These numbers tripled since the year 2000. Furthermore, patients may overdose on antidepressants both intentionally and unintentionally. No matter what the cause is, it is important to be aware of how to manage antidepressant overdose and how to prevent it.
In this article, information about what happens when someone overdose on antidepressants, the signs and symptoms of antidepressants overdose, the association of overdose with suicide, and the first aid for an antidepressants overdose will be provided.
Can You Overdose On Antidepressants?
Some may be wondering: can you overdose on antidepressants? The answer is yes and it is life-threatening. Although antidepressant drugs without a prescription are not available, patients often neglect a doctor’s instructions and use improper amounts to increase effects. Based on a study of medical doctors from Japan, factors such as the person’s weight and age, the presence of preexisting health conditions, how the body metabolizes the drug, and if the antidepressant was taken with other medications or alcohol, can make the toxicity lethal or not. There are various ways in which an individual could OD on antidepressant drugs – intentional and unintentional.
Take a look at the information below:
- An increased number of teenagers and young adults choose to intentionally poison themselves with depression medications due to feelings of distress or conflicts in a school or family.
- Some individuals increase the dose in an attempt to potentiate the drug’s effects, without being aware of the health dangers they expose themselves to.
- Some are under the false belief that if these medications improve mood, taking a higher dose would make them happy.
- Others feel that the medication takes too long to work and use more pills, trying to make them work faster. This happens to those who are not properly informed on how fast antidepressant drugs work.
According to psychiatrists from Oregon, the most common overdoses come from tricyclic antidepressants, with a hospitalization rate of 78.7%. However, it is also possible to OD on SSRIs and SNRIs. Aside from combining antidepressant drugs and alcohol, overdose on antidepressants can also happen when combining depression medication with some foods, such as grapefruit. This fruit contains furanocoumarins, chemicals that disrupt the enzyme that breaks down the medication. This means that the depression medications are not broken down properly, and even a safe dose can increase to dangerous levels. If the drug is absorbed too quickly, it can cause nausea, dizziness, and even toxicity. For some people, depression drugs can make the illness worse, leading to an increased risk of hostility, suicidal thoughts, and sometimes homicidal behavior.
Signs And Symptoms Of Overdose on Antidepressants
What happens when someone overdose on antidepressants depends on the case. As a side effect of the medication, antidepressant weight gain may appear. However, when it comes to intentional overdose, there are common side effects, which vary in intensity from mild to severe. In a study published in the Saudi Pharmaceutical Journal, the symptoms depend on how many pills were ingested, how sensitive the individual is to that specific drug, and if the depression medication was mixed with other drugs. These symptoms are similar to those of antidepressant drugs withdrawal.
Mild Symptoms of Antidepressants Overdose:
- Dilated pupils
- Dry mouth drowsiness
- Blurred vision
- High blood pressure
Severe Symptoms of Antidepressants Overdose:
- Increased heart rate
- Low blood pressure
- Respiratory depression
- Cardiac arrest
Either mild or severe, once a patient starts to show any of these signs and symptoms, it is highly advised to seek medical help as soon as possible. Considering the Poison Help Hotline (1-800-222-1222) would also be of great assistance.
Always Follow the Recommended Dosage
The antidepressant drugs mechanism of action is inhibition of the reuptake of neurotransmitters through selective receptors. There are different antidepressant drug classes such as tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs), and the most crucial factor for toxicity is the type of antidepressant.
To learn which of these drug classes could cause more overdoses and fatalities, take a look at the information below:
|TCAs||Tricyclic antidepressants overdose has the highest number of lethal cases. When compared with other antidepressant drugs, they demonstrate a higher rate of death per one million prescriptions. The daily recommended dose for TCAs varies between 40 and 150 mg per day. In a study from The British Journal of Psychiatry, an analysis of deaths caused by acute poisoning, a rate of 20% was caused by antidepressant drugs, with 95% of them being TCAs.|
|SSRIs||Selective serotonin reuptake inhibitors are believed to be safe antidepressant substances. That is why, if the drug is taken alone, toxicity is rarely fatal. Consistent with the study of researchers from London, the selective serotonin reuptake inhibitor fatality rate is only 0.14% compared to 0.73% for the TCAs.|
|SNRIs||Serotonin-norepinephrine reuptake inhibitors are somewhere between TCAs and SSRIs when it comes to toxicity. The recommended dose of SNRIs varies from 75 to 225 mg per day. But most SNRI overdoses are not fatal if the medication is not mixed with other drugs or alcohol. In a comparative study of medical doctors from Australia, SNRIs are less overdosing than TCAs. However, they can cause more serotonin toxicity compared to SSRIs.|
|MAOIs||Monoamine oxidase inhibitors are not prescribed as much anymore, being considered an older class of antidepressant drugs. The daily dosage of MAOIs varies between 6 mg and 90 mg, depending on the drug. For information purposes, MAOI toxicity increases with drug-drug interaction, overdose, and food-drug interaction (for example, taking an MAOI with alcohol). According to a study from New Jersey, there could be a delay in the symptoms of toxicity of these drugs. For example, when an MAOI drug is taken with alcohol, the toxicity symptoms may appear after several hours.|
|Atypical Antidepressants||Atypical antidepressant drugs can be used as a treatment for depression. However, this group of drugs does not have the same mechanism of action as those typical antidepressant substances. Some of the atypical antidepressant drugs include Trazodone and Bupropion. With regards to their toxicity risk, based on the report of toxicologists from Toronto, 0.5% of overdose cases resulted in death. Additionally, patients can increase their antidepressant overdose risk when these drugs are combined with other substances like alcohol.|
Keep in mind that everyone who is taking antidepressant drugs is at risk of antidepressants overdose. The best way to prevent this toxicity from occurring is by strictly complying with the instructions of a medical doctor. In case of a missed dose or repeated dose, speak to a medical doctor as soon as possible.
Antidepressants Overdose And Suicide Risk
From the 72 antidepressant overdose cases in the South Australian coroner’s office, 68 of these account for the tricyclic antidepressants, specifically Amitriptyline, Doxepin, and Dothiepin. In the same study, it was also reported that these cases are associated with suicide, and women were 2.5 times more likely to use these TCAs to suicide compared to men. From all of these cases, 45% of the patients had previously attempted suicide while 63% of the patients are reported to have mental illnesses. In this section, the reason why antidepressant drugs cause suicidal thoughts, and the law and lawsuits related to this will be provided.
Why Do Antidepressants Cause Suicidal Thoughts?
In some cases, depression medications do the opposite of what they are supposed to do. In a comparative study from the American Journal of Psychiatry, antidepressant drugs, specifically, selective serotonin reuptake inhibitors, cause suicidal thoughts, especially in teenagers and young adults, mainly in the first weeks of the treatment or when the dosage is changed. No one knows exactly what the link between antidepressant drugs and suicide is. Additionally, discontinuing the treatment abruptly suicidal thoughts. In a comparative study from Denver, patients who use multiple antidepressant drugs and those with prior depressive episodes are more at risk for attempted suicide.
Antidepressants-Suicide Law & Lawsuits
As mentioned before, some people, especially the young ones, experience an increased urge towards self-harm and suicide while on antidepressant treatment, being more prone to take an antidepressant overdose. There are many lawsuits involving antidepressant-related suicide, but only a few of them go to trial because most end on settlement. A study from Psychiatria Polska states that antidepressant lawsuits arise as soon as the medication is brought to the market as the clinical trials. However, many pharmaceutical companies hire ghostwriters to interpret fake data about the effects of antidepressant drugs. Because of this, those physicians whose names are written in the articles are being called liable for the suicide effects of the antidepressant drugs.
After a buzz around overdose on antidepressants and related deaths, the regulation became stricter. Since 2004, the FDA urged all manufacturers to include warnings on antidepressant drugs regarding the need to monitor people under treatment of depression for the emergence of suicidal thoughts and worsening depression. Still, there is no direct warning that antidepressant drugs increase suicidal thoughts. Rather, the prescription information indicates that there is a concern that caused by antidepressant medications side effects such as anxiety, agitation, panic attacks, and mania may represent precursors to emerging suicidality.
As mentioned before, some people, especially the young ones, experience an increased urge towards self-harm and suicide while on antidepressant treatment, being more prone to take an antidepressant overdose.
Antidepressants Overdose First Aid
A person who has overdosed on antidepressant drugs needs emergency treatment. When toxicity is suspected, call the ambulance or the Poison Help Hotline (1-800-222-1222) right away to prevent unwanted health dangers.
While Waiting for the Emergency Services to Arrive, the Person Should Stay Calm, Keep the Body Cool, and Follow the Following Tips:
- If the person is found unconscious, turn them into the “coma position” – the body facing down, the head turned to one side, and one knee slightly bent. The airway should be clear, and the person’s breathing and pulse checked regularly. This position helps the patient breathe and avoid choking in case they vomit.
- If there is no pulse, the CPR maneuver can be applied after the victim is turned on the back. Before starting CPR, call the ambulance and tell them the victim is in cardiac arrest, so they know what to bring from the ambulance.
- When the ambulance arrives, they should be shown any empty bottles or packets of pills that the individual might have taken. Once the emergency team examines the individual and takes them to the hospital: the doctors might administer activated charcoal, which can absorb the medication, pump the stomach to remove the medication, and/or give the patient benzodiazepines to reduce agitation if any.
- When the symptoms have been addressed, the patient will be kept in the hospital under observation for at least 12 hours.
According to the Journal of Pharmacy Practice, life-threatening symptoms of antidepressants overdose begin within 2-6 hours. The most important thing to remember in the case of an overdose on antidepressants is to address it as soon as possible and not wait for more symptoms to appear.
Don’t Allow Antidepressants Overdose To Happen
Indeed, all patients who use antidepressants are at risk of toxicity. While others intentionally poison themselves, others are not aware that their actions, such as increasing the dose thinking the drug would work better, are putting their health in danger. Moreover, there are many signs and symptoms of antidepressant overdose, and the best way to avoid this OD is by strictly following the instructions of a medical doctor.
For those who experience antidepressant addiction or feel that antidepressants have taken control over their lives, there are clinics where they can find personalized substance abuse treatment and the help needed. The individual can try other treatments for depression after discussing it with a primary care provider, such as natural antidepressant supplements or a different medication if the current one is not appropriate.
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- Battersby, M. W., O'mahoney, J. J., Beckwith, A. R., & Hunt, J. L. (1996). Antidepressant deaths by overdose. Australian and New Zealand journal of psychiatry, 30(2), 223-228.
- Christiaens, F., Lessire, H., Dellers, I., Denis, B., Vankeerberghen, L., & Verborgh, C. (2000). Successful prolonged cardiopulmonary resuscitation after a combined intoxication with a tricyclic antidepressant, a benzodiazepine and a neuroleptic. European journal of emergency medicine: official journal of the European Society for Emergency Medicine, 7(3), 229-236.
- Cohen, H., Hoffman, R. S., & Howland, M. A. (1997). Antidepressant poisoning and treatment: a review and case illustration. Journal of Pharmacy Practice, 10(4), 249-270.
- Dargan, P. I., Colbridge, M. G., & Jones, A. L. (2005). The Management of Tricyclic Antidepressant Poisoning. Toxicological reviews, 24(3), 187-194.
- Giorgi-Guarnieri, D. (2019). Clinician Liability in Prescribing Antidepressants. Focus, 17(4), 372-379.
- Hawton, K., Bergen, H., Simkin, S., Cooper, J., Waters, K., Gunnell, D., & Kapur, N. (2010). Toxicity of antidepressants: rates of suicide relative to prescribing and non-fatal overdose. The British Journal of Psychiatry, 196(5), 354-358.
- Henry, J. A., Alexander, C. A., & Sener, E. K. (1995). Relative mortality from overdose of antidepressants. Bmj, 310(6974), 221-224.
- Juurlink, D. N., Mamdani, M. M., Kopp, A., & Redelmeier, D. A. (2006). The risk of suicide with selective serotonin reuptake inhibitors in the elderly. American Journal of Psychiatry, 163(5), 813-821.
- Lenzer, J. (2004). FDA panel urges “black box” warning for antidepressants. BMJ, 329(7468), 702.
- McKenzie, M. S., & McFarland, B. H. (2007). Trends in antidepressant overdoses. Pharmacoepidemiology and drug safety, 16(5), 513-523.
- Nagashima, K., Sumida, M., Imanaka, S., Kuwabara, T., Kaneko, I., Miyake, Y., ... & Watanabe, M. (2021). Evaluation of factors related to overdose in patients with impaired consciousness who are transported by emergency medical services: an age-specific research. Journal of pharmaceutical health care and sciences, 7(1), 1-7.
- Valuck, R. J., Orton, H. D., & Libby, A. M. (2009). Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. The Journal of clinical psychiatry, 70(8), 0-0.
- Watson, W. A., Litovitz, T. L., Rodgers, G. C., Klein-Schwartz, W., Reid, N., Youniss, J., ... & Wruk, K. M. (2005). 2004 annual report of the American association of poison control centers toxic exposure surveillance system. The American journal of emergency medicine, 23(5), 589-666.
- White, N. C., Litovitz, T., & Clancy, C. (2008). Suicidal antidepressant overdoses: a comparative analysis by antidepressant type. Journal of medical toxicology, 4(4), 238-250.
- Whyte, I. M., Dawson, A. H., & Buckley, N. A. (2003). Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants. Qjm, 96(5), 369-374.