Introduction and Objectives: A fatal case involving the concomitant intake of mirtazapine, escitalopram and valproic acid is reported. Mirtazapine and escitalopram are antidepressant drugs currently prescribed by psychiatrists for the treatment of depression. Valproic acid has been used as an anticonvulsant drug since 1967, but it has more recently been employed in the treatment of the manic depressive phase of bipolar disorders. These drugs are more recent than traditional tricyclic antidepressants (TCA) and are reported to be less toxic; however, intoxication due to overdose has been repeatedly reported. Case Report: In the present case, a 64-year-old woman with a previous history of chronic depression was found dead in her apartment. Several packages of pharmaceutical drugs were found, including mirtazapine, escitalopram and valproic acid. During the autopsy, no evidence of natural disease or trauma was found to account for this death. In order to determine whether massive drug consumption might have caused a lethal intoxication; heart blood, urine and gastric contents were collected and submitted for toxicological analyses. Specific LC-MS/MS protocols were developed and validated. Blood concentrations of mirtazapine, escitalopram and valproic acid were 20.3 mg/L, 65.5 mg/L and 417 mg/L, respectively. Urine concentrations were 17.0 mg/L, 94.5 mg/L and 423 mg/L. High concentrations of these drugs were also detected in the gastric contents confirming their ingestion shortly before death. Conclusion: The agreement between autopsy examination by forensic pathologists and toxicological findings confirmed the suicidal hypothesis. The cause of death was by drug intoxication due to simultaneous high-dose ingestion of mirtazapine, escitalopram and valproic acid.
A fatal case of simultaneous ingestion of mirtazapine, escitalopram and valproic acid
GERACE, ENRICO;A. Salomone;VINCENTI, Marco
2011-01-01
Abstract
Introduction and Objectives: A fatal case involving the concomitant intake of mirtazapine, escitalopram and valproic acid is reported. Mirtazapine and escitalopram are antidepressant drugs currently prescribed by psychiatrists for the treatment of depression. Valproic acid has been used as an anticonvulsant drug since 1967, but it has more recently been employed in the treatment of the manic depressive phase of bipolar disorders. These drugs are more recent than traditional tricyclic antidepressants (TCA) and are reported to be less toxic; however, intoxication due to overdose has been repeatedly reported. Case Report: In the present case, a 64-year-old woman with a previous history of chronic depression was found dead in her apartment. Several packages of pharmaceutical drugs were found, including mirtazapine, escitalopram and valproic acid. During the autopsy, no evidence of natural disease or trauma was found to account for this death. In order to determine whether massive drug consumption might have caused a lethal intoxication; heart blood, urine and gastric contents were collected and submitted for toxicological analyses. Specific LC-MS/MS protocols were developed and validated. Blood concentrations of mirtazapine, escitalopram and valproic acid were 20.3 mg/L, 65.5 mg/L and 417 mg/L, respectively. Urine concentrations were 17.0 mg/L, 94.5 mg/L and 423 mg/L. High concentrations of these drugs were also detected in the gastric contents confirming their ingestion shortly before death. Conclusion: The agreement between autopsy examination by forensic pathologists and toxicological findings confirmed the suicidal hypothesis. The cause of death was by drug intoxication due to simultaneous high-dose ingestion of mirtazapine, escitalopram and valproic acid.
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