In meta-analyses of randomized controlled trials, Wayne et al. found that SSRIs might

increase suicide ideation, but found no evidence that suicide risk was increased [9]. Because of a shift in prescription pattern, SSRIs are now more commonly used than older anti-depressants [5]. Therefore, it would be expected that SSRIs be found more often than TCAs in this Inhibitors,research,lifescience,medical study. However, only 26% of those who committed suicide had taken anti-depressants, supporting studies suggesting that under-treatment of depression is a greater problem than an eventual increased risk of suicide by specific compounds [25]. The present finding of anti-depressants in 25% of accidental deaths presumably reflects their therapeutic use and is possibly an indicator of depression. Furthermore, this illustrates the Z-VAD-FMK supplier potential problems encountered when evaluating the intended outcome of an acute poisoning post-mortem. Ethanol and Inhibitors,research,lifescience,medical benzodiazepines are important co-drugs in acute poisonings, but were found to be the main toxic agents in nine and four fatalities, respectively. However, Inhibitors,research,lifescience,medical because these drugs are the most commonly found in acute poisonings in Oslo [12], the percentage of deaths per poisoning episode was low, about 1%. Ethanol was the main toxic agent in 9% of all fatal poisonings and an additional agent in 17%. Enhanced respiratory depression

is important in multiple-drug poisonings, both with opioids [1] and psychoactive drugs [8]. Benzodiazepines caused 4% of all fatal poisonings, in

Inhibitors,research,lifescience,medical accordance with findings from England, where benzodiazepines caused 3.8% of all deaths caused by single-drug poisoning. However, 75% of all deaths had benzodiazepines as the main or additional drugs. Zopiclone is increasingly used as a sedative compared with benzodiazepines, Inhibitors,research,lifescience,medical as the potential for drug dependency is thought to be less evident. However, there were 8% deaths per poisoning episode for zopiclone vs. 1% for benzodiazepines in the present study, although others have concluded that the fatal toxicity was the same for both sedatives [26]. Acute poisoning by zopiclone mimics Terminal deoxynucleotidyl transferase benzodiazepine poisoning clinically, and could have been classified as such in the non-fatal cases. Furthermore, case fatality rates were calculated for main toxic agents only, but many clinicians might have considered zopiclone a less harmful drug and therefore an additional agent in many cases, which could be a possible bias. Paracetamol was the main agent in two fatalities but an additional agent in 11. Combinations of paracetamol and codeine were quite common. In such cases, the main agent was thought to be paracetamol in hospitalized patients, because of the potential for liver damage, and codeine in forensic cases, because of presumed respiratory depression causing death before liver failure occurred.