Tricyclic antidepressant poisoning in Wales 1999-2003

Objective: To determine the pattern of tricyclic antidepressant poisoning in Wales between 1999 and 2003. Method: Telephone enquiries to NPIS (Cardiff Centre) concerning tricyclic antidepressant poisoning were collated as were the number of ‘hits’ on the TOXBASE internet information database. Health Solution Wales and the National Statistics Board provided statistics on accident and emergency department admissions and mortality from tricyclic antidepressant poisoning. These data were examined for the years 1999–2003. Results: Telephone enquiries to NPIS (Cardiff Centre) concerning tricyclics antidepressants declined form 740 in 1999 to 338 in 2003. However, internet enquiries increased substantially from only 23 in 1999 to 638 in 2003. Admissions from A and E departments declined substantially but this fall was not reflected in the number of deaths which showed little change. Table 1 gives data for tricyclic antidepressant poisoning in Wales between 1999 and 2003. Discussion: The change in telephone and internet use to obtain information about poisoned patients reflects national trends and the promotion of TOXBASE as a first tier database for poisons information. The lack of a change in deaths is disappointing and is likely to reflect the early mortality which occurs with severe tricyclic poisoning, with the majority of deaths occurring outside hospital. Conclusion: These data demonstrate a fall in hospital attendances with tricyclic antidepressant poisoning without a corresponding fall in mortality. Intervention strategies to decrease mortality must address this issue. Altered prescribing practice offers an opportunity to decrease mortality. Provision of advice once a patient has presented to hospital is likely to have a more limited effect on mortality.