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

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]

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]

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

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]

• 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]

  The effect of 5-hydroxytryptamine 3A and 3B receptor genes on nausea induced by paroxetine. Pharmacogenomics J 2006; 6 : 351–356. 39. Gerstenberg G, Aoshima T, Fukasawa T, Yoshida K, Takahashi H, Higuchi H et al. [nature.com]

• Abdominal Pain

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

• 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]

  Main Results: The frequency distribution of sinus tachycardia, “QRS more than 100 ms, R/S aVR equal or more than 0.7, RaVR equal or more than 3 mm�, arrhythmia, and generalized tonic colonic seizure was less in patients who had co-ingested BDZ with [scopemed.org]

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

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

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

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

Sodium bicarbonate is used for treatment of these complications which may have some effect on serum sodium levels. [advbiores.net]

[…] 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]

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

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]

Indications for sodium bicarbonate in tricyclic antidepressant overdose: Severe cardiotoxicity cardiac arrest ventricular dysrhythmias hypotension resistant to fluid challenge Consider for prevention of severe cardiotoxicity resulting from: seizure – [lifeinthefastlane.com]

This may prevent hyperthermia and rhabdomyolysis. The use of hypertonic saline in CA toxicity remains controversial. [emedicine.medscape.com]