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Fluoxetine and violent death in
Maryland.
Frankenfield DL, Baker SP, Lange WR,
Caplan YH, Smialek JE.
Johns Hopkins University, School of
Public Health, Baltimore, MD.
A retrospective Medical Examiner
case review of all deaths in Maryland where either fluoxetine or
tricyclic antidepressant (TCA) use was forensically detected was
conducted for the time period January 1987-July 1991. Case records and
toxicology reports from the Office of the Chief Medical Examiner were
reviewed to determine cause and manner of death, circumstances of death,
demographic information on the decedent, prior medical history of the
decedent, and presence and level of either fluoxetine or TCA in various
body fluids/tissues. Suicide was the manner of death most frequently
associated with TCA and fluoxetine detection. Violent methods were more
often associated with fluoxetine suicides than with TCA suicides (65% v.
23%, P < 0.001). Demographic characteristics of
antidepressant-related deaths in Maryland were similar to those of the
entire USA. Possible explanations for the results obtained include the
inherent lower lethality of fluoxetine compared to the TCAs,
necessitating the use of additional means to complete the act of
suicide; that physicians may have switched more impulsive, high risk
patients to this new agent as it became available, thus creating a
selection bias for more violence-prone individuals in the fluoxetine
group; or that fluoxetine may be associated with induction of violence
and/or suicidal ideation. Further research examining the possible
association of these agents with violent acts is warranted.
PMID:
8175081 [PubMed - indexed for MEDLINE]
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