Coroner's Finding: Mr R

61y · Male·combined drug intoxication (doxepin, mianserin and fluoxetine)

A 61-year-old man died from combined drug intoxication involving doxepin, mianserin, and fluoxetine—all antidepressants prescribed over several years. He self-medicated with previously prescribed medications, likely attempting to manage worsening depressive symptoms without medical consultation. Toxicology showed doxepin at fatal levels, fluoxetine above therapeutic range, and therapeutic mianserin. No evidence suggested intentional self-harm; he had positive future plans. Clinical lessons: when changing antidepressants, ensure patients destroy unused prior prescriptions; counsel patients on dangers of mixing antidepressants and exceeding prescribed doses; maintain awareness of depressive symptom changes and medication adherence; consider regular medication review in patients with multiple psychiatric prescriptions over time.