Goulas Antonis, Raikos Nikolaos, Krokos Diamantis, Mastrogianni Orthodoxia, Orphanidis Amvrosios, Zisopoulos Konstantinos, Tsepa Androniki
1st Department of Pharmacology, Medical School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
Department of Forensic Medicine and Toxicology, Medical School, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
Forensic Sci Med Pathol. 2018 Jun;14(2):225-228. doi: 10.1007/s12024-018-9960-3. Epub 2018 Feb 27.
Serotonin-specific reuptake inhibitors (SSRIs) are generally considered safe drugs but fatal adverse effects do sometimes occur, often as a consequence of interactions with other serotonin active drugs. Polypharmacy is usually a problem that the elderly encounter, but it can also have dire consequences for young people, especially when an underlying heart condition is present. Thus, failure to diagnose heart disease and the use of contraindicated medications can be a lethal combination, irrespective of age. Here we present a case of a young adult suffering from bipolar disorder who used a combination of two SSRIs (citalopram and fluoxetine) and a monoamine oxidase inhibitor (MAO; moclobemide) with tragic consequences. The deceased also suffered from undiagnosed hypertrophic cardiomyopathy and was carrier of a genotype that may have predisposed him to increased sensitivity to SSRIs. The apparent difficulty in establishing the manner of death in this case is also discussed.
血清素特异性再摄取抑制剂（SSRI）通常被认为是安全的药物，但有时确实会出现致命的不良反应，这往往是与其他血清素活性药物相互作用的结果。多种药物并用通常是老年人面临的一个问题，但对年轻人也可能产生严重后果，尤其是当存在潜在心脏疾病时。因此，未能诊断出心脏病以及使用禁忌药物可能是一种致命组合，无论年龄大小。在此，我们报告一例患有双相情感障碍的年轻成年人病例，该患者同时使用了两种SSRI（西酞普兰和氟西汀）以及一种单胺氧化酶抑制剂（MAO；吗氯贝胺），结果悲惨。死者还患有未被诊断出的肥厚型心肌病，并且携带一种可能使他对SSRI更敏感的基因型。本文还讨论了在此病例中确定死亡方式时明显存在的困难。
