Clinical Severity and Serotonin Toxicity in Antidepressant Self-Poisoning: Implications for Clinical Risk Assessment
- 1Department of Psychiatry, Health Sciences University Etlik City Hospital, Ankara, Türkiye
- 2Department of Emergency Medicine, Ankara Bilkent City Hospital, Ankara, Türkiye
Abstract
Background: Antidepressant self-poisoning is a common form of intentional self-harm, and comparisons across antidepressant groups are complicated by differences in ingested dose and coexposures.
Methods: This retrospective cross-sectional study reviewed emergency department presentations coded with International Classification of Diseases, 10th Revision (ICD-10) X61/X64 between 01 January 2023 and 15 May 2025. Among 15,160 screened records, 168 patients with documented antidepressant ingestion with self-harm/suicidal intent were included. Antidepressant exposures were classified by group and standardized using defined daily dose (DDD). Clinical presentation, serotonin toxicity based on the Hunter Serotonin Toxicity Criteria, management, and short-term outcomes were evaluated. Multivariable logistic regression was used to adjust for log-transformed DDD.
Results: The median age was 27.0 years, and 66.7% of patients were female. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently ingested antidepressants (79.8%). Symptomatic presentation occurred in 33.3% of patients and was more frequent in non-SSRI than in SSRI exposures (55.9% vs 27.6%; adjusted OR, 3.40; 95% CI, 1.55-7.43; P = .002). Serotonin toxicity was identified in 7.7% and was also more frequent in non-SSRI exposures (23.5% vs 3.7%; adjusted OR, 8.17; 95% CI, 2.45–27.26; P = .001). Serotonin toxicity was associated with intensive care unit (ICU) admission (53.8% vs 10.3%; P < .001).
Conclusion: Non-SSRI antidepressant exposures were associated with greater short-term clinical severity than SSRI exposures. Because non-SSRI subgroups were small and heterogeneous, class-specific findings should be interpreted as exploratory. The early clinical pattern of toxicity may inform short-term risk assessment.
Related
- Selective Serotonin Reuptake Inhibitor-Associated Bruxism: Neuropharmacologic Mechanisms and Clinical Implications
- Comparison of Clinical and Ultrasonographic Severity Assessment in Hidradenitis Suppurativa: Prognostic Implications.
- Thymic hyperplasia in patients with acromegaly: imaging-based assessment and clinical implications.
- Recent Clinical Encounters for Suicidal Thoughts and Behaviours: Disclosure, Assessment, Missed Opportunities, and Implications for Practice
- Clinical context enhances interpretation of extracorporeal treatment criteria in lithium poisoning
BibTeX
@article{guru2026clinical,
title = {{Clinical Severity and Serotonin Toxicity in Antidepressant Self-Poisoning: Implications for Clinical Risk Assessment}},
author = {Meltem Gürü and Merve Unutmaz},
journal = {Psychiatry and clinical psychopharmacology},
year = {2026},
month = aug,
doi = {10.65801/pcp.3541},
url = {https://europepmc.org/article/PMC/PMC13720837},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Clinical Severity and Serotonin Toxicity in Antidepressant Self-Poisoning: Implications for Clinical Risk Assessment
AU - Meltem Gürü
AU - Merve Unutmaz
PY - 2026
DA - 2026/08/01
JO - Psychiatry and clinical psychopharmacology
DO - 10.65801/pcp.3541
UR - https://europepmc.org/article/PMC/PMC13720837
AB - Background: Antidepressant self-poisoning is a common form of intentional self-harm, and comparisons across antidepressant groups are complicated by differences in ingested dose and coexposures. Methods: This retrospective cross-sectional study reviewed emergency department presentations coded with International Classification of Diseases, 10th Revision (ICD-10) X61/X64 between 01 January 2023 and 15 May 2025. Among 15,160 screened records, 168 patients with documented antidepressant ingestion with self-harm/suicidal intent were included. Antidepressant exposures were classified by group and standardized using defined daily dose (DDD). Clinical presentation, serotonin toxicity based on the Hunter Serotonin Toxicity Criteria, management, and short-term outcomes were evaluated. Multivariable logistic regression was used to adjust for log-transformed DDD. Results: The median age was 27.0 years, and 66.7% of patients were female. Selective serotonin reuptake inhibitors (SSRIs) were the most frequently ingested antidepressants (79.8%). Symptomatic presentation occurred in 33.3% of patients and was more frequent in non-SSRI than in SSRI exposures (55.9% vs 27.6%; adjusted OR, 3.40; 95% CI, 1.55-7.43; P = .002). Serotonin toxicity was identified in 7.7% and was also more frequent in non-SSRI exposures (23.5% vs 3.7%; adjusted OR, 8.17; 95% CI, 2.45–27.26; P = .001). Serotonin toxicity was associated with intensive care unit (ICU) admission (53.8% vs 10.3%; P < .001). Conclusion: Non-SSRI antidepressant exposures were associated with greater short-term clinical severity than SSRI exposures. Because non-SSRI subgroups were small and heterogeneous, class-specific findings should be interpreted as exploratory. The early clinical pattern of toxicity may inform short-term risk assessment.
SN - 2475-0581
ER -