Citation

Overberg A, Morton S, Wagner E, Froberg B. Pediatrics 2019; 144(2): ePub.

Affiliation

Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana.

Copyright

(Copyright © 2019, American Academy of Pediatrics)

DOI

10.1542/peds.2018-3295

PMID

31278211

Abstract

OBJECTIVES: Adolescent depression and attempted and completed suicide are increasing in the United States. Because suicide is often impulsive, the means of self-harm are frequently items of convenience like medication. Authors of a recent study compared tricyclic antidepressant overdose to bupropion overdose. Fluoxetine and escitalopram are the only agents with Food and Drug Administration approval for pediatric depression, but off-label bupropion prescriptions are common. We sought to compare the effects of selective serotonin reuptake inhibitors (SSRIs) and bupropion in overdose.

METHODS: This was an analysis of the National Poison Data System from June 2013 through December 2017 for adolescent (ages 10-19) exposures to SSRIs or bupropion coded as "suspected suicide." Demographics, clinical effects, therapies, and medical outcome were analyzed.

RESULTS: There were 30 026 cases during the study period. Sertraline and fluoxetine accounted for nearly 60%, whereas bupropion was reported in 11.7%. Bupropion exposure was significantly associated with death (0.23% vs 0%; P <.001) or serious outcome (58.1% vs 19%; P <.001) as well as the 10 most common clinical effects, including seizures (27.0% vs 8.5%; P <.001) and hallucinations (28.6% vs 4.3%; P <.001). Bupropion exposure was significantly associated with the need for cardiopulmonary resuscitation (0.51% vs 0.01%; P <.001), intubation (4.9% vs 0.3%; P <.001), vasopressors (1.1% vs 0.2%; P <.001), and benzodiazepines (34.2% vs 5.5%; P <.001). There was a significant increase in all exposures and in proportion of serious outcomes over time.

CONCLUSIONS: Adolescents who attempt self-harm are at higher risk for serious morbidity and poor outcomes with bupropion than with SSRIs. These risks, and the patient's propensity for self-harm, should be evaluated when therapy with bupropion is considered.

Copyright © 2019 by the American Academy of Pediatrics.

Language: en