Barbiturates Still Drugs of Choice in Geriatric Suicide

From Medscape Medical News
Pam Harrison

March 11, 2010 (Savannah, Georgia) — Barbiturates are still the drugs of first choice among adults 60 years and older who commit suicide by overdose, despite a significant decrease in their use since 1990.

In a study presented here at the American Association for Geriatric Psychiatry 2010 Annual Meeting, Robert C. Abrams, MD, Weill Cornell Medical College, New York City, found that 27.2% of adults 60 years and older living in New York City who overdosed fatally between 1990 and 2006 used barbiturates. Furthermore, 26% of adults 60 years and older died of antidepressant overdose.

In contrast, only 11.8% of New York adults between the ages of 18 and 59 years died by using barbiturates during the same study interval, whereas 42.8% of them used antidepressants.

Approximately 85% of both age groups died from overdose using psychotropics, analgesics, or ethanol during the 16 years surveyed. Barbiturate use decreased from approximately 30% in 1990 to 10% in 2006.

"The comparatively high rates of antidepressant overdose in young adults could reflect problems of delivery of antidepressants to depressed elders," Dr. Abrams told Medscape Psychiatry.
However, he added, "physicians should be aware of the persistent potential of barbiturates to be lethal agents among elderly patients."

Dr. Abrams noted that people who commit suicide by overdose often take more than 1 medication. However, if the medical authorities at the time thought that an antidepressant or a barbiturate had contributed to the death, the medication was counted; as a result, percentages of patients who used different medications to commit suicide were expected to exceed 100%.

Dr. Abrams also told Medscape Psychiatry that suicidal overdose using nonnarcotic analgesics, such as nonsteroidal anti-inflammatory drugs, is increasing among older adults as well.

"Most old people do not commit suicide by overdosing — falls from height and firearms still proportionally outweigh overdosing as the method of choice for suicide," said Dr. Abrams. "But," he added, "the barbiturates are highly lethal, and people may use them if they still have them in their medicine cabinets."

Ellen Whyte, MD, University of Pittsburgh Medical Center, Pennsylvania, told Medscape Psychiatry that the first message from this study is that there is a need for physicians to attend to the risks for suicide in late life, especially among older white men who are at high risk for suicide, though, typically, through more violent means, such as guns.

"This study points to the fact that older individuals still may kill themselves through overdose, and we have to be careful about the medications we prescribe and the quantities we prescribe them in when treating elderly patients."

American Association for Geriatric Psychiatry (AAGP) 2010 Annual Meeting: Abstract NR5. Presented March 6, 2010.

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