Patterns of SSRI Exposures Reported to the U.S. Poison Centers
Abstract
Objectives: We sought to characterize the SSRIs exposures reported to the U.S. National Poison Data System (NPDS).
Background: More than 20 million antidepressants were prescribed between October and December 2020, a significant increase compared to the same months in the prior year. In 2017, a selective serotonin reuptake inhibitors (SSRIs) was mentioned in 57,254 single-substance toxic exposures reported to United States poison centers (PCs).
Methods: The NPDS was queried for all human exposures to SSRIs reported to the U.S. Poison Centers (PCs) between 2015 and 2020. We descriptively assessed the demographic and clinical characteristics. Calls from acute care hospitals and hospital based EDs (ACH) were studied as a subgroup. Trends in SSRI exposures were analyzed using Poisson regression with percent changes being reported.
Results: There were 346,082 SSRI exposure calls made to the PCs from 2015 to 2020, with the number of calls increasing from 51,791 to 62,504 during the study period. Single substance exposures accounted for 45.5% of such SSRI exposures. Of the total SSRI calls, the proportion of calls from acute care hospitals and EDs decreased from 56.2% to 53.2% from 2015 to 2020. Multiple substance exposures accounted for 65.5% of the overall SSRI calls from acute care hospitals and EDs. Approximately 15% of the patients reporting SSRI exposures were admitted to the critical care unit (CCU), with 18.8% patients admitted to a psychiatric unit. Residence was the most common site of exposure (94.2%), and 63.9% of these cases were enroute to the hospital via EMS when the PC was notified. Among the patients, 66.7% were male, with individuals between ages 13 and 19 years (31%) predominantly reported SSRI exposures. Suspected suicides (58.5%) and therapeutic errors (18.6%) were commonly observed reasons for exposure, with the former accounting for 83% cases reported by ACH. Major effects were seen in 3.7% cases and the case fatality rate for SSRI was 0.3%. Sertraline was the most commonly observed SSRI (23.6%). The most frequently co-occurring substances associated with the cases were atypical antipsychotics (9.3%) and benzodiazepines (8%). Tachycardia (19.7%) and drowsiness/lethargy (15.6%) were commonly observed clinical effects. During the study period, the frequency of SSRI exposures increased by 19.9% (95% CI: 16.2%, 22.7%; p<0.001), and the rate of SSRI exposures increased by 23.1% (95% CI: 15.2%, 29.2%; p<0.001).
Conclusion: There was a significant increase in the reports of SSRI exposures during the study with sertraline being the most commonly reported SSRI. Suspected suicides was the most common reason for exposure. Greater intervention and awareness initiatives are needed considering the severity of such overdoses.