Recent data shows that the number of antidepressant overdoses in the US has increased every year between 1999 and 2022.
The analysis of CDC overdose data was published last month because the organization needs more than a year to process overdose data; 2022 is the most recent year for which complete overdose data is available.
Antidepressants were an underlying cause of death in 5,863 overdoses that year – a number that is on par with heroin-related overdoses, which killed 5,871 people in the same year. These represent a small but significant percentage of the rising overdose deaths – totaling more than 100,000 in 2022, mostly from fentanyl.
Annual reports from the National Poison Data System, which collects data from the 55 poison control centers in the U.S., also show that poisonings involving antidepressants have steadily increased each year since the organization released an annual report, from 2012 to 2022. While the vast majority of fatalities involving the drug also involved other substances, 56 people died in 2022 from antidepressant exposure alone, according to to the latest report – the highest number ever measured.
These numbers have been climbing for as long as data have been available, and it’s hard to say exactly why. Information is missing from the data, including the precise mix of substances involved in each death, making it unclear how many are the result of suicide.
Phil Cowen, professor of psychopharmacology at the University of Oxford, says the rise is “likely linked to the opioid epidemic in the US”.
He explains that the CDC data show that “the number of antidepressant overdose deaths without opioids is fairly stable; however, there has been an increase in deaths involving both antidepressants and opioids.”
Cowen added that “patients who experience chronic pain and patients with clinical depression are more likely to commit suicide. These patients are also more likely to use opioids and antidepressants.”
Multiple pharmacology experts According to The Guardian, which was approached for this story, the rise in overdoses could simply be due to an increase in the number of antidepressants prescribed.
While some experts argued that the number of overdoses was a logical consequence of increased prescriptions and therefore not a cause for concern, others worried that the increase in both prescriptions and overdoses illustrates the failure of the medical community to adequately recognize and address the risks of antidepressants. The medication has been linked to numerous negative health outcomesincluding a increase in premature mortality according to a 2017 meta-analysis.
David Healy, a psychiatrist and psychopharmacologist at Bangor University who monitors the safety of prescribed medicineshas a number of theories about the increase in overdoses.
In the past, it was common to take antidepressants for only a few months. Now, many patients have I’ve been working on it for yearshe says, what the risk of severe withdrawal And suicide attempts when they try to stop taking them. He added that doctors are increasingly reluctant to take patients seriously or take them off the medication when they report negative experiences with the medication.
Instead, Healy said, they now prescribe additional medications psychotropic drugs on top of antidepressants. Sometimes patients add alcohol or non-prescribed opioids to the mix to offset the negative effects of a cocktail of medications. these factors may increase the risk of accidental overdose or suicide attemptHealy said, adding: “In between things, maybe because they were a little sedated, they took more than they should have and died.”
The risk of fatal overdose from antidepressants alone is extremely low, although tricyclic antidepressants are riskier than othersBut antidepressants can increase patients’ risk of suicide, which can lead to overdoses.
In 2004, the FDA introduced a black boxwarning that antidepressants can lead to suicidality in adolescents and young adults. The label was controversial, with antidepressant advocates insisting that the drugs prevent more suicides than they cause, and publishing studies in this direction.
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Glen Spielmans, a professor of psychology at Metropolitan State University, investigated whether this was the case by carefully evaluating clinical trial data on antidepressants. He and his colleagues published their findings 2020He argued that the warning on thewas justified because pharmaceutical companies had downplayed the risk of suicide in their published clinical trials of antidepressants.
“There were cases where suicide attempts occurred during clinical trials that had disappeared by the time you read the scientific paper,” Spielmans said.
Both suicide rates And antidepressant prescriptions have climbed in recent years for teens and young adults. But Spielmans warns against reading too much into these two developments.
“There are so many things you don’t know based on those two variables that I think it’s very difficult to connect them,” he explained.
Rising rates of depression and social stressors could explain these numbers, as they “would lead to more people using antidepressants and also more people committing suicide,” Spielmans said.
The analysis CDC overdose data show that the number of suicides involving antidepressants increased by 2% per year between 1999 and 2015 and has leveled off since then. However, the authors also say that suicides are often misclassified as unintentional overdoses.
Spielmans is adamant that doctors need to be more vigilant when prescribing antidepressants. They could help minimize risk by checking in with patients more often, though Spielmans admits that may not be practical in our overburdened health care system. Doctors should also be upfront with patients about the possibility that antidepressants can trigger suicidal thoughts, Spielmans says, since patients are most at risk for suicide when they first start taking the medication, when they increase their dosage, or when they stop taking it.
“If I were a patient and I was taking medication and suddenly I felt worse,” he said, “I would want to know if it was possible that the medication was making my condition worse, rather than my condition.”