If suicidal ideation is present, evaluation for admission to a psychiatric facility is mandatory. [emedicine.medscape.com]

These patients often present with fits, coma, and cardiac arrhythmias. Death from cardiac arrest may also occur. Symptoms usually appear within 30 to 60 minutes of ingestion, and reach their peak intensity within 4 to 12 hours. [gpnotebook.co.uk]

This case presents comatose and tricyclic antidepressant overdose. It includes a full discussion and explanation with an emphasis on the mechanism of coma in this particular case, in addition to subsequent management and expected outcome. [oxfordmedicine.com]

The present case illustrates two potential advantages of ILE utilisation in tricyclic antidepressant cardiotoxicity. [intjem.springeropen.com]

This highlights the importance of suspecting oral intoxication with sodium blocking drugs in an unconscious patient who presents with a BEP. [innovationsincrm.com]

• Hyperthermia

  Physical Exam Anticholinergic Toxidrome may be present Physical exam findings include: mydriasis, dry and hot skin, urinary and bowel retention, hyperthermia, xerostomia, tachycardia and AMS (disorientation, confusion) Pulmonary: Coarse breath sounds [coreem.net]

  Seizures are rare in SSRI overdose, with the exception of citalopram, which has an increased risk of inducing seizures in both adults and children. [14, 15] Autonomic nervous system effects include diaphoresis, mydriasis, hypertension, tachycardia, hyperthermia [emedicine.medscape.com]

  Severe hyperthermia. Tremors. Seizures. Hallucinations. Dilated pupils. Dry mouth. Breathing problems. High blood pressure. Rapid or irregular heart rate. Cardiovascular collapse. Unresponsiveness. Coma. [recovery.org]

  Hypoxia, acidosis, hyperthermia, convulsion, and beta adrenergic agonists can make patients susceptible to ventricular tachycardia. [2], [3] QTc prolongation results from slow depolarization which leads to torsades de pointes. [advbiores.net]

• Anorexia

  Role of antidepressants in the treatment of adults with anorexia nervosa. Mental Health Clinician, Vol. 8, Issue. 3, p. 127. [cambridge.org]

• Nausea

  In an overdose situation, they can potentially cause: Agitation Fainting Nausea Vomiting Diarrhea Dizziness Fever Seizures Tricyclic antidepressants Tricyclics include drugs like Tofranil, Norpramin, and Surmontil. [amphetamines.com]

  This can include insomnia and symptoms similar to flu like a headache and nausea. Constipation. Trouble urinating. Dry mouth. Weight gain. Possible sexual dysfunction. Blurred vision. Abdominal pain. Anxiety. [medtox.org.uk]

  Symptoms may include: Confusion Agitation or restlessness Dilated pupils Headache Changes in blood pressure and/or temperature Nausea and/or vomiting Diarrhea Rapid heart rate Tremor Loss of muscle coordination or twitching muscles Shivering and goose [webmd.com]

  Risk Assessment Symptoms in overdose are typically mild and are manifestations of serotonin excess, including nausea, vomiting and dizziness. Uncommonly serotonin toxicity can occur and should be actively looked for. [emergpa.net]

  […] syndrome, and the dose should not exceed 40mg daily. [18] Due to the high levels of serotonin in gastric and intestinal mucosal enterochromaffin cells, the most common minor adverse effects of SSRI therapy are gastrointestinal; eg, abdominal cramping, nausea [emedicine.medscape.com]

• Absent Bowel Sounds

  Physical Exam Anticholinergic Toxidrome may be present Physical exam findings include: mydriasis, dry and hot skin, urinary and bowel retention, hyperthermia, xerostomia, tachycardia and AMS (disorientation, confusion) Pulmonary: Coarse breath sounds [coreem.net]

  bowel sounds High fever, or inability to regulate temperature Anhidrosis Delirium Metabolic features Metabolic acidosis Respiratory acidosis Management of tricyclic overdose Decontamination Activated charcoal reduces absorption and can be used in single [derangedphysiology.com]

• Abdominal Pain

  Abdominal pain. Anxiety. The side-effects of antidepressant medication will vary according to which type you are using. [medtox.org.uk]

• Muscle Rigidity

  Features of this syndrome include hyperpyrexia, disseminated intravascular coagulation, convulsions, coma and muscle rigidity, which may not develop until 6 to 12 hours after overdose. [ncbi.nlm.nih.gov]

• Xerostomia

  Physical Exam Anticholinergic Toxidrome may be present Physical exam findings include: mydriasis, dry and hot skin, urinary and bowel retention, hyperthermia, xerostomia, tachycardia and AMS (disorientation, confusion) Pulmonary: Coarse breath sounds [coreem.net]

• Tachycardia

  […] in the setting of ARDS Cardiovascular Hypotension secondary to direct myocardial depression from blockade of fast-acting sodium channels AND antagonism of peripheral alpha-1 receptors (eg vasodilation) Tachycardia: initially sinus tachycardia and in cases [coreem.net]

  If the ventricular tachycardia does not respond to the magnesium then a lidocaine infusion at 1.0-1.5 mg/kg up to 3 mg/kg should be given. [ems1.com]

  This may also help reduce tachycardia, and thus decrease use-dependent Na channel blockade. 6. [lifeinthefastlane.com]

  Cardiovascular effects most commonly include sinus tachycardia, flushing, hypertension, and in rare cases, hypotension. [emedicine.medscape.com]

  Such patients may present with dilated pupils, dry mouth, drowsiness, sinus tachycardia, urinary retention, increased tendon reflexes, and extensor plantar responses. Severe poisoning usually occurs when more than 15 - 20 mg/kg is ingested. [gpnotebook.co.uk]

• Flushing

  […] bowel sounds, suprapubic fullness secondary to urinary retention Neuro: Initially altered mental status including delirium and agitation followed by lethargy and stupor, seizure activity, myoclonus, dystonia, akathisia, rigidity, myoclonus Skin: dry, flushed [coreem.net]

  In addition to cardiotoxicity and potential QRS prolongation, TCA overdose can cause anticholinergic effects (e.g., flushing, dry mouth, dilated pupils, and hyperpyrexia) and central nervous system (CNS) effects (e.g., confusion and hallucinations). [clinicaladvisor.com]

  Cardiovascular effects most commonly include sinus tachycardia, flushing, hypertension, and in rare cases, hypotension. [emedicine.medscape.com]

  […] alpha-blocking effects and myocardial depression) broad complex tacydysrrhythmia broad complex bradycardia occurs pre-arrest anticholinergic effects may occur on present or may be delayed and prolonged agitation, restlessness, delirium mydriasis dry, warm flushed [lifeinthefastlane.com]

• Urinary Retention

  Such patients may present with dilated pupils, dry mouth, drowsiness, sinus tachycardia, urinary retention, increased tendon reflexes, and extensor plantar responses. Severe poisoning usually occurs when more than 15 - 20 mg/kg is ingested. [gpnotebook.co.uk]

  Physical Exam Anticholinergic Toxidrome may be present Physical exam findings include: mydriasis, dry and hot skin, urinary and bowel retention, hyperthermia, xerostomia, tachycardia and AMS (disorientation, confusion) Pulmonary: Coarse breath sounds [coreem.net]

  In an overdose situation, this anticholinergic effect can result in dry mouth, blurry vision, urinary retention, underactive bowel movements, fever and involuntary muscle twitches. [livestrong.com]

  retention, Ileus Antiadrenergic: Vasodilation Investigations TCA levels useful if diagnosis in doubt, not useful as a predictor of outcome ECG on admission and repeated if abnormalities found: QRS >100ms associated with seizures, QRS>160ms associated [rch.org.au]

  Anticholinergic effects : Dilated pupils; dry mouth; pyrexia from impaired thermal autoregulation and reduced sweating; myoclonic jerks; urinary retention; ileus; toxic megacolon; intestinal perforation. [icmcasesummaries.com]

• Agitation

  These side-effects are known as Tardive Dyskinesia/Dystonia (severe body movement disorder, mostly permanent), Parkinsonism (a sign of future Parkinson's disease) and Akathisia (a Neurological driven severe mania/agitation that can lead to suicidality [antidepressantsfacts.com]

  For example, benzodiazepines are given to treat agitation and/or seizures. Intravenous fluids are given to maintain hydration. Removing the drug responsible for the serotonin syndrome is critical. [webmd.com]

  […] develop wide-complex tachycardia as a result of QRS prolongation and/or refractory hypotension Abdomen: hypoactive or absent bowel sounds, suprapubic fullness secondary to urinary retention Neuro: Initially altered mental status including delirium and agitation [coreem.net]

  Excess 5-HT in these pathways causes the mental status changes, confusion, agitation, ataxia, and fever associated with SSRI toxicity and SS. [emedicine.medscape.com]

  The first signs of antidepressant overdose are usually nausea, drowsiness, dry mouth, agitation, headache, vomiting, and diarrhea, all of which can easily be attributed to other causes. [verywellmind.com]

• Mydriasis

  Physical Exam Anticholinergic Toxidrome may be present Physical exam findings include: mydriasis, dry and hot skin, urinary and bowel retention, hyperthermia, xerostomia, tachycardia and AMS (disorientation, confusion) Pulmonary: Coarse breath sounds [coreem.net]

  Seizures are rare in SSRI overdose, with the exception of citalopram, which has an increased risk of inducing seizures in both adults and children. [14, 15] Autonomic nervous system effects include diaphoresis, mydriasis, hypertension, tachycardia, hyperthermia [emedicine.medscape.com]

  The most common symptoms were conscious level changes (81.52%) and mydriasis (64.1%). [advbiores.net]

  […] hypotension (alpha-blocking effects and myocardial depression) broad complex tacydysrrhythmia broad complex bradycardia occurs pre-arrest anticholinergic effects may occur on present or may be delayed and prolonged agitation, restlessness, delirium mydriasis [lifeinthefastlane.com]

  Clinically, serotonin toxicity is characterised by a triad of clinical effects: (1) neuromuscular hyperactivity—clonus, myoclonus, tremor or hyperreflexia; (2) autonomic hyperactivity—diaphoresis, fever, tachycardia or mydriasis; and (3) altered mental [nature.com]

• Myoclonus

  dystonia, akathisia, rigidity, myoclonus Skin: dry, flushed, hot skin Psych: hallucinations, picking at objects that are not there Diagnostics EKG Sinus tachycardia Intraventricular conduction delay Prolonged QRS >100ms Rightward shift of the T40-msec [coreem.net]

  Toxicity of descending pathways to the brainstem and medulla results in hyperreflexia, myoclonus, and tremor. [emedicine.medscape.com]

  […] is a very dangerous and a potentially fatal side effect of the serotonergic enhancing drugs such as SSRI & SSNRI antidepressants and is diagnosed by the presence of at least 3 of 10 symptoms: mental status changes (confusion, hypomania), agitation, myoclonus [antidepressantsfacts.com]

  Clinically, serotonin toxicity is characterised by a triad of clinical effects: (1) neuromuscular hyperactivity—clonus, myoclonus, tremor or hyperreflexia; (2) autonomic hyperactivity—diaphoresis, fever, tachycardia or mydriasis; and (3) altered mental [nature.com]

• Akathisia

  Tardive Dyskinesia/Dystonia, Parkinsonism & Akathisia S SRI & SSNRI antidepressants induced side-effects (Iatrogenic Extrapyramidal Symptoms) are recognized to be similar to Neuroleptic (anti-psychotic) induced side-effects. [antidepressantsfacts.com]

  […] hypotension Abdomen: hypoactive or absent bowel sounds, suprapubic fullness secondary to urinary retention Neuro: Initially altered mental status including delirium and agitation followed by lethargy and stupor, seizure activity, myoclonus, dystonia, akathisia [coreem.net]

  Akathisia can be described as a subjective sense of unease and motor restlessness. It can be misinterpreted as increasing agitation or anxiety. [cancertherapyadvisor.com]

• Dystonia

  Tardive Dyskinesia/Dystonia, Parkinsonism & Akathisia S SRI & SSNRI antidepressants induced side-effects (Iatrogenic Extrapyramidal Symptoms) are recognized to be similar to Neuroleptic (anti-psychotic) induced side-effects. [antidepressantsfacts.com]

  […] refractory hypotension Abdomen: hypoactive or absent bowel sounds, suprapubic fullness secondary to urinary retention Neuro: Initially altered mental status including delirium and agitation followed by lethargy and stupor, seizure activity, myoclonus, dystonia [coreem.net]

  Acute dystonia is a hyperkinetic movement disorder that manifests as intermittent or sustained muscle contractions. [cancertherapyadvisor.com]

• Wide QRS Complex

  He is found to have a wide QRS complex and an anticholinergic toxidrome. The patient deteriorates into PEA arrest necessitating advanced cardiac life support (ACLS) and intravenous sodium bicarbonate therapy. [emsimcases.com]

  Patients with acute intoxication and wide QRS complex usually have changes in their level of consciousness. [advbiores.net]

  Electrocardiogram (ECG) abnormalities are frequent and a wide variety of cardiac dysrhythmias can occur, the most common being sinus tachycardia and intraventricular conduction delay resulting in prolongation of the QRS complex and the PR / QT intervals [en.wikipedia.org]

The treatment of an asymptomatic patient with a history of CA ingestion is mainly supportive therapy. [emedicine.medscape.com]

Antidepressant overdose treatment typically takes place in an emergency room. [recovery.org]

Efficacy of long duration resuscitation and magnesium sulphate treatment in amitriptyline poisoning. [pharmacytimes.com]

If you have been abusing drugs and are concerned about possible side effects, including addiction, you may need treatment. [amphetamines.com]

[…] outcomes following treatment with clozapine, which modifies serotonergic activity in the brain, 19 and the 5-HT 2A polymorphism has also been investigated for a possible role in antidepressant treatment outcomes, but results to date have shown only marginal [nature.com]

Prognosis In general, patients who arrive alive at health care facilities have a very good prognosis. Most deaths from these agents occur in the prehospital period. Thus, if an individual survives to hospital admission, the prognosis is quite good. [cancertherapyadvisor.com]

Antidepressant serum levels show no correlation to severity or prognosis of intoxication. Lactate production is increased due to respiratory depression and mixed acidosis. [pharmacytimes.com]

Use of over-the-counter medications or dietary supplements in addition to prescribed serotonergic medications is also an important etiology. [emedicine.medscape.com]

Diagnostic approach History is the essential in determining the etiology of the symptoms. Certainly aggressive supportive care is key, and patient care should not be delayed while trying to obtain a history. [cancertherapyadvisor.com]

Tricyclic antidepressants are highly protein bound and have a large volume of distribution ; therefore removal of these compounds from the blood with hemodialysis, hemoperfusion or other techniques are unlikely to be of any significant benefit. [12] Epidemiology [en.wikipedia.org]

He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education. [lifeinthefastlane.com]

Epidemiology As the prevalence of psychiatric disorders increases in Western society, there is a corresponding increase in the number of prescriptions written for these medications. Overdose of psychiatric medications is quite common. [cancertherapyadvisor.com]

The exact pathophysiology of serotonin toxicity is still not fully understood, except that it occurs with an excess of serotonin in the central nervous system. [nature.com]

[…] toxic dose. [7] Factors that increase the risk of toxicity include advancing age, cardiac status, and concomitant use of other drugs. [8] However, serum drug levels are not useful for evaluating risk of arrhythmia or seizure in tricyclic overdose. [9] Pathophysiology [en.wikipedia.org]

Pathophysiology Antidepressants Antidepressants work by different mechanisms, but ultimately most attempt to correct an imbalance of the dopaminergic, noradrenergic, and serotonergic systems. [cancertherapyadvisor.com]

If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255. If you suspect an overdose has occurred, seek emergency medical care right away. [healthline.com]

Sit the person upright to prevent choking on vomit. If the person is unconscious, leave him/her on his/her side to help keep airways clear. [recovery.org]

Restriction of access to methods of suicide as a means of suicide prevention. In Prevention and Treatment of Suicidal Behaviour: From Science to Practice : 279–91. [cambridge.org]

A Word From Verywell Antidepressants can be a life-restoring therapy, but you should be aware of the risks so you can prevent overdoses and get treatment immediately if you recognize the signs. [verywellmind.com]

They prevent the reabsorption of serotonin and norepinephrine. [amphetamines.com]