{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:26:28Z","timestamp":1792679188375,"version":"4.5.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Antidepressants and antipsychotics are both an important class of prescription drugs within postmortem (PM) toxicology because most of the substances are toxic in overdose and the mental disorders being treated may be associated with suicidality. A wide range of antidepressants and antipsychotics are currently included in up-to-date PM toxicology analysis protocols. However, apart from case studies, few reports on fatal concentrations based on large number of cases have been published in the literature. Based on PM investigations in Finland between 2000 and 2020, this study provides fatal reference concentrations in poisonings due to an antidepressant or an antipsychotic drug assigned as the principal intoxicant. Summary statistics for drug concentrations in PM femoral blood (min, max, mean, 10th, 25th, 50th, 75th, 90th percentile) were calculated for 17 antidepressant (N\u2009=\u20092,007) and for 12 antipsychotic drugs (N\u2009=\u20091,161). The proportion of suicide, accident and undetermined manner of death is indicated for each drug. Further, the fatal concentrations obtained in this study were evaluated by comparison with fatal and \u201cnormal\u201d PM concentrations reported by two previously published approaches, the grouped causes of death approach and the all causes of death approach, respectively. This study shows that, despite the well-known variation in PM drug concentrations, competently generated fatal concentration results for the drugs studied are consistent to such an extent that they can be used as a reference in the interpretation process.<\/jats:p>","DOI":"10.1093\/jat\/bkad044","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T16:16:38Z","timestamp":1689264998000},"page":"615-622","source":"Crossref","is-referenced-by-count":10,"title":["Fatal concentrations of\u00a0antidepressant and\u00a0antipsychotic drugs in\u00a0postmortem femoral blood"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5721-2827","authenticated-orcid":false,"given":"Pirkko","family":"Kriikku","sequence":"first","affiliation":[{"name":"Forensic Toxicology Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Mannerheimintie 166 , Helsinki FI-00271, Finland"},{"name":"Department of Forensic Medicine, University of Helsinki, P.O. Box 21, Haartmaninkatu 3 , Helsinki FI-00014, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5790-1473","authenticated-orcid":false,"given":"Ilkka","family":"Ojanper\u00e4","sequence":"additional","affiliation":[{"name":"Forensic Toxicology Unit, Finnish Institute for Health and Welfare (THL), P.O. Box 30, Mannerheimintie 166 , Helsinki FI-00271, Finland"},{"name":"Department of Forensic Medicine, University of Helsinki, P.O. Box 21, Haartmaninkatu 3 , Helsinki FI-00014, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"key":"2023091515450298500_R1","volume-title":"StatPearls","author":"Sheffler","year":"2023"},{"key":"2023091515450298500_R2","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1007\/s00702-022-02542-0","article-title":"Off-label use of\u00a0antidepressants, antipsychotics, and\u00a0mood-stabilizers in\u00a0psychiatry","volume":"129","author":"Hefner","year":"2022","journal-title":"Journal of Neural Transmission (Vienna)"},{"key":"2023091515450298500_R3","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s00414-016-1358-8","article-title":"Fatal toxicity index of\u00a0medicinal drugs based on\u00a0a comprehensive toxicology database","volume":"130","author":"Ojanper\u00e4","year":"2016","journal-title":"International Journal of Legal Medicine"},{"key":"2023091515450298500_R4","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jad.2022.02.001","article-title":"Indications related to antidepressant prescribing in\u00a0the Nivel-PCD database and\u00a0the SIDIAP database","volume":"303","author":"Camacho-Arteaga","year":"2022","journal-title":"Journal of Affective Disorders"},{"key":"2023091515450298500_R5","volume-title":"StatPearls","author":"Chokhawala","year":"2023"},{"key":"2023091515450298500_R6","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1093\/jat\/11.5.191","article-title":"A comparison of\u00a0postmortem heart blood and\u00a0femoral blood ethyl alcohol concentrations","volume":"11","author":"Prouty","year":"1987","journal-title":"Journal of Analytical Toxicology"},{"key":"2023091515450298500_R7","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1520\/JFS12828J","article-title":"The forensic science implications of\u00a0site and\u00a0temporal influences on\u00a0postmortem blood-drug concentrations","volume":"35","author":"Prouty","year":"1990","journal-title":"Journal of Forensic Sciences"},{"key":"2023091515450298500_R8","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/0379-0738(90)90182-X","article-title":"Post-mortem drug redistribution - a toxicological nightmare","volume":"45","author":"Pounder","year":"1990","journal-title":"Forensic Science International"},{"key":"2023091515450298500_R9","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-020-02915-5","article-title":"Revisited: therapeutic and\u00a0toxic blood concentrations of\u00a0more than 1100 drugs and\u00a0other xenobiotics","volume":"24","author":"Schulz","year":"2020","journal-title":"Critical Care"},{"key":"2023091515450298500_R10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.forsciint.2004.02.017","article-title":"Fatal blood and\u00a0tissue concentrations of\u00a0more than 200 drugs","volume":"142","author":"Musshoff","year":"2004","journal-title":"Forensic Science International"},{"key":"2023091515450298500_R11","volume-title":"Disposition of Toxic Drugs and Chemicals in Man","author":"Baselt","year":"2017","edition":"11th"},{"key":"2023091515450298500_R12","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1520\/JFS14071J","article-title":"A compilation of\u00a0fatal and\u00a0control concentrations of\u00a0drugs in\u00a0postmortem femoral blood","volume":"42","author":"Druid","year":"1997","journal-title":"Journal of Forensic Sciences"},{"key":"2023091515450298500_R13","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1258\/rsmmsl.49.4.257","article-title":"Concentration distributions of\u00a0the drugs most frequently identified in\u00a0post-mortem femoral blood representing all causes of\u00a0death","volume":"49","author":"Jones","year":"2009","journal-title":"Medicine, Science, and the Law"},{"key":"2023091515450298500_R14","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1002\/dta.1507","article-title":"Drug concentrations in\u00a0post-mortem femoral blood compared with therapeutic concentrations in\u00a0plasma","volume":"6","author":"Launiainen","year":"2014","journal-title":"Drug Testing and Analysis"},{"key":"2023091515450298500_R15","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/jat\/31.5.254","article-title":"Reference concentrations of\u00a0antidepressants. A compilation of\u00a0postmortem and\u00a0therapeutic levels","volume":"31","author":"Reis","year":"2007","journal-title":"Journal of Analytical Toxicology"},{"key":"2023091515450298500_R16","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.forsciint.2016.05.002","article-title":"Antipsychotics - postmortem fatal and\u00a0non-fatal reference concentrations","volume":"266","author":"S\u00f6derberg","year":"2016","journal-title":"Forensic Science International"},{"key":"2023091515450298500_R17","doi-asserted-by":"crossref","DOI":"10.1016\/j.forsciint.2020.110292","article-title":"The importance of\u00a0sample size with regard to the robustness of\u00a0postmortem reference values","volume":"311","author":"S\u00f6derberg","year":"2020","journal-title":"Forensic Science International"},{"key":"2023091515450298500_R18","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1002\/dta.2655","article-title":"Summary statistics for\u00a0drug concentrations in\u00a0post-mortem femoral blood representing all causes of\u00a0death","volume":"11","author":"Ketola","year":"2019","journal-title":"Drug Testing and Analysis"},{"key":"2023091515450298500_R19","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1002\/dta.1818","article-title":"Patterns of\u00a0drug abuse among drug users with regular and\u00a0irregular attendance for\u00a0treatment as detected by comprehensive UHPLC-HR-TOF-MS","volume":"8","author":"Sundstr\u00f6m","year":"2016","journal-title":"Drug Testing and Analysis"},{"key":"2023091515450298500_R20","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/S1570-0232(02)01012-7","article-title":"Precise gas chromatography with retention time locking in\u00a0comprehensive toxicological screening for\u00a0drugs in\u00a0blood","volume":"788","author":"Rasanen","year":"2003","journal-title":"Journal of Chromatography. B, Analytical Technologies in the Biomedical and Life Sciences"},{"key":"2023091515450298500_R21","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.forsciint.2016.08.031","article-title":"Concurrent estimation of\u00a0metabolite concentrations along with parent drug quantification in\u00a0post-mortem blood","volume":"267","author":"Viinam\u00e4ki","year":"2016","journal-title":"Forensic Science International"},{"key":"2023091515450298500_R22","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/jat\/bkaa107","article-title":"Postmortem drug redistribution: a compilation of\u00a0postmortem\/antemortem drug concentration ratios","volume":"45","author":"Mantinieks","year":"2021","journal-title":"Journal of Analytical Toxicology"},{"key":"2023091515450298500_R23","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.forsciint.2016.06.026","article-title":"The relationship between bupropion and\u00a0suicide in\u00a0post-mortem investigations","volume":"266","author":"Kriikku","year":"2016","journal-title":"Forensic Science International"},{"key":"2023091515450298500_R24","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1080\/15563650.2017.1377839","article-title":"Suicidal bupropion ingestions in\u00a0adolescents: increased morbidity compared with other antidepressants","volume":"56","author":"Sheridan","year":"2018","journal-title":"Clinical Toxicology (Phila)"},{"key":"2023091515450298500_R25","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1093\/jat\/bky058","article-title":"Degradation of\u00a0bupropion: implications for\u00a0interpretation of\u00a0postmortem case data","volume":"42","author":"Bishop-Freeman","year":"2018","journal-title":"Journal of Analytical Toxicology"},{"key":"2023091515450298500_R26","doi-asserted-by":"crossref","DOI":"10.1186\/s12888-018-1993-3","article-title":"Relative toxicity of\u00a0mood stabilisers and\u00a0antipsychotics: case fatality and\u00a0fatal toxicity associated with self-poisoning","volume":"18","author":"Ferrey","year":"2018","journal-title":"BMC Psychiatry"},{"key":"2023091515450298500_R27","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1001\/archpsyc.60.1.82","article-title":"Clozapine treatment for\u00a0suicidality in\u00a0schizophrenia: International Suicide Prevention Trial (InterSePT)","volume":"60","author":"Meltzer","year":"2003","journal-title":"Archives of General Psychiatry"},{"key":"2023091515450298500_R28","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1007\/BF03161207","article-title":"Suicidal antidepressant overdoses: a comparative analysis by antidepressant type","volume":"4","author":"White","year":"2008","journal-title":"Journal of Medical Toxicology"},{"key":"2023091515450298500_R29","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1192\/bjp.bp.109.070219","article-title":"Toxicity of\u00a0antidepressants: rates of\u00a0suicide relative to prescribing and\u00a0non-fatal overdose","volume":"196","author":"Hawton","year":"2010","journal-title":"British Journal of Psychiatry"},{"key":"2023091515450298500_R30","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1176\/appi.ajp.2016.16050523","article-title":"Morbidity and\u00a0mortality associated with medications used in\u00a0the treatment of\u00a0depression: an analysis of\u00a0cases reported to U.S. poison control centers, 2000-2014","volume":"174","author":"Nelson","year":"2017","journal-title":"American Journal of Psychiatry"},{"key":"2023091515450298500_R31","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1055\/s-0043-116492","article-title":"Consensus guidelines for\u00a0therapeutic drug monitoring in\u00a0neuropsychopharmacology: update 2017","volume":"51","author":"Hiemke","year":"2018","journal-title":"Pharmacopsychiatry"}],"container-title":["Journal of Analytical Toxicology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jat\/advance-article-pdf\/doi\/10.1093\/jat\/bkad044\/50878700\/bkad044.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/47\/7\/615\/51606550\/bkad044.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jat\/article-pdf\/47\/7\/615\/51606550\/bkad044.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T17:18:33Z","timestamp":1694798313000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jat\/article\/47\/7\/615\/7223849"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,13]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,13]]},"published-print":{"date-parts":[[2023,9,15]]}},"URL":"https:\/\/doi.org\/10.1093\/jat\/bkad044","relation":{},"ISSN":["0146-4760","1945-2403"],"issn-type":[{"value":"0146-4760","type":"print"},{"value":"1945-2403","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,9,15]]},"published":{"date-parts":[[2023,7,13]]}}}