Citalopram in overdose may result in serious morbidity and death

Editor—When talking about selective serotonin reuptake inhibitors in his comprehensive review of depressive illness, Hale states that “All seem safe in overdose.”1 Fresh evidence suggests that this may not be so.

The most recently introduced, and most selective, selective serotonin reuptake inhibitor—citalopram—is associated with electrocardiographic changes and generalised seizures in overdose.2 These abnormalities include widened QRS complexes at doses above 600 mg (15-30 times the usual therapeutic dose). All patients reported on were treated with gastric lavage or given activated charcoal and survived with supportive treatment. An electrocardiography database exists for more than 1700 patients taking therapeutic doses …