Drug treatment of depression

BMJ 1998;316:307-308 (24 January)

Letters

Drug treatment of depression

Citalopram in overdose may result in serious morbidity and death

Editor–When talking about selective serotonin reuptakeinhibitors in his comprehensive review of depressive illness,Hale states that "All seem safe in overdose."¹ Fresh evidencesuggests that this may not be so.

The most recently introduced, and most selective, selectiveserotonin reuptake inhibitor—citalopram—is associatedwith electrocardiographic changes and generalised seizures inoverdose.² These abnormalities include widened QRS complexesat doses above 600 mg (15-30 times the usual therapeutic dose).All patients reported on were treated with gastric lavage orgiven activated charcoal and survived with supportive treatment.An electrocardiography database exists for more than 1700 patientstaking therapeutic doses of citalopram, and no important electrocardiographicabnormalities, particularly QTc changes, were observed.³ Thisshows that the true safety of a drug, particularly in overdose,cannot be fully determined until the drug has seen extensiveclinical use.