The relationship between bupropion and suicide in post-mortem investigations

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http://hdl.handle.net/10138/228782

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Kriikku , P & Ojanpera , I 2016 , ' The relationship between bupropion and suicide in post-mortem investigations ' , Forensic Science International , vol. 266 , pp. 343-348 . https://doi.org/10.1016/j.forsciint.2016.06.026

Title: The relationship between bupropion and suicide in post-mortem investigations
Author: Kriikku, Pirkko; Ojanpera, Ilkka
Contributor: University of Helsinki, Medicum
University of Helsinki, Medicum
Date: 2016-09
Language: eng
Number of pages: 6
Belongs to series: Forensic Science International
ISSN: 0379-0738
URI: http://hdl.handle.net/10138/228782
Abstract: We reviewed the 33 727 postmortem toxicology investigations performed in Finland over a period of 5 years (2009-2013) and identified those in which the antidepressant bupropion was detected. Cases positive for other antidepressant drugs were reviewed for comparison. The postmortem toxicological examination included, in all cases, the routine screening and quantification of hundreds of drugs and poisons using quality-controlled methods. Bupropion was detected in 65 cases. A large proportion of the bupropion-positive deaths resulted from suicide (55%). In fatal poisoning cases found positive for bupropion, the proportion of suicide was even higher (77%). The measured median bupropion postmortem blood concentration (0.69 mg/L) was markedly higher than the normal therapeutic range in plasma in the treatment of depression (up to 0.1 mg/L) and even higher in fatal bupropion poisonings (13 mg/L). Only 14% of the deceased positive for bupropion were estimated to be drug abusers. However, nearly all of the drug abuse cases were from the last year of the study (2013), indicating a recent increase of the use of bupropion among drug abusers and possibly even abuse of bupropion itself. Suicide victims positive for bupropion were younger than those who died with other antidepressant drugs in their blood. In addition, the percentage of fatal poisonings among bupropion-positive postmortem cases was higher than among the users of other antidepressant drugs. Suicide was significantly more common among the deceased positive for bupropion than among users of other antidepressant drugs. An unknown degree of bupropion degradation before the assay and post-mortem redistribution of bupropion may have impacted the measured levels. Nonetheless, all post-mortem concentrations of bupropion were elevated and especially high concentrations were detected in suicides. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
Subject: Forensic toxicology
Bupropion
Antidepressant
Suicide
Fatal poisoning
Postmortem
MAJOR DEPRESSIVE DISORDER
ANTIDEPRESSANT MEDICATION
NASAL INSUFFLATION
RELEASE BUPROPION
DRUG-ADDICTS
ABUSE
OVERDOSE
DEATH
METABOLITES
RESOLUTION
319 Forensic science and other medical sciences
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