Antidepressants and antipsychotics are both an important class of prescription drugs within post-mortem (PM) toxicology because most of the substances are toxic in overdose and the mental disorders being treated may be associated with suicidality. A wide range of antidepressants and antipsychotics are currently included in up-to-date PM toxicology analysis protocols. However, apart from case studies, few reports on fatal concentrations based on large number of cases have been published in the literature. Based on PM investigations in Finland between 2000–2020, this study provides fatal reference concentrations in poisonings due to an antidepressant or an antipsychotic drug assigned as the principal intoxicant. Summary statistics for drug concentrations in PM femoral blood (min, max, mean, 10th, 25th, 50th, 75th, 90thpercentile) were calculated for 17 antidepressant (N = 2007) and for 12 antipsychotic drugs (N = 1161). The proportion of suicide, accident and undetermined manner of death is indicated for each drug. Further, the fatal concentrations obtained in this study were evaluated by comparison with fatal and “normal” PM concentrations reported by two previously published approaches, the grouped causes of death approach and the all causes of death approach, respectively. This study shows that, despite the well-known variation in PM drug concentrations, competently generated fatal concentration results for the drugs studied are consistent to such an extent that they can be used as a reference in the interpretation process.

中文翻译：

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死后股血中抗抑郁药和抗精神病药的致死浓度

抗抑郁药和抗精神病药都是死后 (PM) 毒理学中一类重要的处方药，因为大多数物质服用过量都会有毒，而且所治疗的精神障碍可能与自杀有关。目前最新的 PM 毒理学分析方案中包含多种抗抑郁药和抗精神病药。然而，除了案例研究外，文献中很少发表基于大量病例的致命浓度报告。本研究基于 2000 年至 2020 年芬兰的 PM 调查，提供了因抗抑郁药或抗精神病药物被指定为主要麻醉剂而导致中毒的致命参考浓度。计算了 17 种抗抑郁药 (N = 2007) 和 12 种抗精神病药 (N = 1161) 的 PM 股血中药物浓度的汇总统计数据（最小值、最大值、平均值、第 10 个、第 25 个、第 50 个、第 75 个、第 90 个百分位数）。每种药物都标明了自杀、事故和不明死亡方式的比例。此外，通过与先前发表的两种方法（分别是分组死因方法和所有死因方法）报告的致命和“正常”PM浓度进行比较，评估了本研究中获得的致命浓度。这项研究表明，尽管 PM 药物浓度存在众所周知的变化，但所研究药物的致命浓度结果在一定程度上是一致的，可以在解释过程中用作参考。