Three safety indices for the fourteen most prescribed antidepressants in the US, 2013–2020

Abstract

ObjectiveThis study provides three prevalence-based metrics of potential harm, the fatal toxicity index (FTI), serious morbidity index (SMI) and healthcare utilization index (HUI) for fourteen of the most prescribed antidepressants in the US. MethodFor the years 2013–2020, adverse events for single drug exposures were obtained from the National Poison Data System. Prescription estimates were taken from the Agency for Healthcare Research and Quality's Medical Expenditure Survey. 95% confidence intervals were calculated using a Poisson distribution. Chi-square testing was used where significance was not clear. ResultsSSRIs and SNRIs had the lowest overall indices (FTI 0.02–0.26). Bupropion's FTI (0.27–0.43) was not statistically significantly different from that of imipramine (FTI 0–1.3, p = .62) or nortriptyline (FTI 0.25–0.78, p = .22), though its SMI and HUI were significantly greater. There was a statistically significant difference in all indices between TCAs (p < .0047). The difference between the FTI of all SSRIs did not remain significant after correction (p = .045). ConclusionSSRIs and SNRIs are safer than alternative agents on all measures. Bupropion exposure was as likely to cause mortality, and more likely to cause morbidity or require treatment in a healthcare facility, than TCAs nortriptyline and imipramine.