Abrams Robert C, Leon Andrew C, Tardiff Kenneth, Marzuk Peter M, Li Chunshan, Galea Sandro
Department of Psychiatry, Weill Cornell Medical College, New York, N.Y. 10021, USA.
J Clin Psychiatry. 2009 Mar;70(3):312-7. doi: 10.4088/jcp.08m04243. Epub 2009 Feb 10.
We examined postmortem evidence of antidepressant, analgesic, and anxiolytic-hypnotic drugs in suicide victims aged 65 years and older.
We assessed data on Medical Examiner-certified suicide victims aged 65 years or older from 2001 through 2004 who had resided and died in New York City and who underwent toxicologic investigation for antidepressant, analgesic, and anxiolytic-hypnotic drugs. We calculated annual population-based suicide rates and rates of positive toxicologic findings for each of the 3 classes of medications across 3 age strata: 65 to 74, 75 to 84, and 85 years and older.
There were 255 certified suicide victims among New York City residents aged 65 years or older from 2001 through 2004. Results of toxicologic testing were available for 63.5% (162) of suicide victims. Antidepressants were detected in 22.0% of suicide victims aged 65 to 74 years, 26.8% of those aged 75 to 84 years, and 16.7% of those aged 85 years and older. The oldest age stratum had both the highest suicide rates in the over-65-years population at 10.7 per 100,000 and the lowest percentage of antidepressant use among all geriatric suicide victims.
Rates of detection of antidepressant medication were low for all geriatric suicide victims, especially the oldest. Analgesics and anxiolytic-hypnotics may have been taken in lieu of antidepressants by suicide victims aged 85 years and older. Assuming that many of the suicide victims had clinically treatable depression, these findings implicate problems in the delivery of specific antidepressant pharmacologic treatment to the "old-old."
我们研究了65岁及以上自杀受害者体内抗抑郁药、镇痛药和抗焦虑催眠药的尸检证据。
我们评估了2001年至2004年期间居住并死于纽约市、年龄在65岁及以上、经法医鉴定为自杀且接受了抗抑郁药、镇痛药和抗焦虑催眠药毒理学调查的受害者的数据。我们计算了3个年龄层（65至74岁、75至84岁、85岁及以上）中每类药物基于人群的年自杀率和毒理学阳性结果率。
2001年至2004年期间，纽约市65岁及以上的居民中有255名经法医鉴定为自杀的受害者。63.5%（162名）自杀受害者的毒理学检测结果可用。在65至74岁的自杀受害者中，22.0%检测出抗抑郁药；75至84岁的受害者中，这一比例为26.8%；85岁及以上的受害者中，这一比例为16.7%。最年长的年龄层在65岁以上人群中的自杀率最高，为每10万人中有10.7人自杀，且在所有老年自杀受害者中抗抑郁药使用比例最低。
所有老年自杀受害者中抗抑郁药的检出率都很低，尤其是最年长的受害者。85岁及以上的自杀受害者可能服用了镇痛药和抗焦虑催眠药来替代抗抑郁药。假设许多自杀受害者患有临床上可治疗的抑郁症，这些发现暗示了在为“高龄老人”提供特定抗抑郁药物治疗方面存在问题。
