The only prognostic indicator of death in such patients is seizure after hospital presentation. [ncbi.nlm.nih.gov]

When presented with the limited history of an unknown ingestion in a patient with altered mental status, a clinician depends on the physical examination and a toxic screen to determine the ingested substance(s). [pediatrics.aappublications.org]

• Weakness

  A tricyclic overdose may cause: Hallucinations Drowsiness Enlarged pupils Fever Irregular heartbeat Severe dizziness Severe muscle stiffness or weakness Restlessness or agitation Breathing problems, respiratory failure Vomiting Convulsions Coma A TCA [healthyplace.com]

  (Surmontil) (relatively weak serotonin reuptake inhibitor)Those that preferentially inhibit the reuptake of norepinephrine (by at least 10-fold over serotonin) include: Desipramine (Norpramin, Pertofrane) Dibenzepin‡ (Noveril, Victoril) Lofepramine§ [en.wikipedia.org]

  Because of the potential severity of TCA poisoning, transportation by EMS, with close monitoring of clinical status and vital signs en route, should be considered (Grade D). 3) Patients who are symptomatic (e.g., weak, drowsy, dizzy, tremulous, palpitations [ncbi.nlm.nih.gov]

  […] with enlarged prostate Fever Sensitivity to sunlight Drowsiness Anxiety Restlessness Difficulty focusing, forgetfulness Confusion Dizziness Restlessness Changes in appetite or weight Sweating Decrease in sexual desire or ability Twitches and tremors Weakness [anti-depressants.com]

  Tricyclics Side Effects The most prominent side effects of tricyclics are postural hypotension (dizziness on standing due to a drop in blood pressure), drowsiness, weakness, headache, dry mouth, blurred vision, constipation, nausea, and difficulty urinating [healthcommunities.com]

• Fatigue

  Immune Deficiency Syndrome (CFIDS) Chronic Fatigue Syndrome Chronic Hepatitis Chronic Obstructive Pulmonary Disease Chronic Pancreatitis Chronic Pelvic Pain Syndrome (in men) Chronic Prostatitis Cigarette Addiction Cigarette Smokers, Nutrition Cirrhosis [therapy.epnet.com]

  Tricyclics can cause: Dry mouth Constipation Blurred vision Sleepiness Weight loss Weight gain Sweating Shaking Issues with your sex life If you take duloxetine, you might have: Nausea Dizziness Fatigue Headaches At first, SSRIs also can make you: Nauseated [webmd.com]

  This delivery method helps decrease some side effects, such as dry mouth and fatigue. After a few weeks, side effects usually diminish considerably. [medicinenet.com]

  Possible side effects of tricyclic antidepressants include: dry mouth dry eyes blurred vision dizziness fatigue headache disorientation seizure (especially with maprotiline) drowsiness constipation urinary retention sexual dysfunction low blood pressure [healthline.com]

  However, many of the atypical antidepressants can cause nausea, fatigue, weight gain, sleepiness, nervousness, dry mouth, and blurred vision. [helpguide.org]

• Fever

  Later you may experience tremors and muscle spasms or seizures, confusion, delirium, hallucinations, very high fever, rapid heart rate, high blood pressure, seizures and coma. Serotonin syndrome can result in death. [anti-depressants.com]

  sudden high fever with jaundice, priapism (condition marked by persistent erections), swollen lymph nodes and respiratory distress. [drugs.nmihi.com]

  A tricyclic overdose may cause: Hallucinations Drowsiness Enlarged pupils Fever Irregular heartbeat Severe dizziness Severe muscle stiffness or weakness Restlessness or agitation Breathing problems, respiratory failure Vomiting Convulsions Coma A TCA [healthyplace.com]

  High fever, convulsions, and even death can occur from such combinations. Epinephrine ( Primatene, Adrenalin, Ana-Kit, EpiPen, Marcaine ) should not be used with tricyclic antidepressants, since together they can cause severe high blood pressure. [rxlist.com]

  Although rare, an interaction between these drugs may cause high fever, tremors, agitation, restlessness, or, in some cases, death. [healthcommunities.com]

• Hypothermia

  Peter B Hedlund, Lisa Kelly, Curt Mazur, Timothy Lovenberg, J.Gregor Sutcliffe and Pascal Bonaventure, 8-OH-DPAT acts on both 5-HT1A and 5-HT7 receptors to induce hypothermia in rodents, European Journal of Pharmacology, 10.1016/j.ejphar.2004.01.031, [doi.org]

• Congestive Heart Failure

  Heart Failure Conjunctivitis Constipation Constipation (in Pregnancy) Contusions COPD Coronary Artery Disease (CAD) Coronary Heart Disease Cough Crohn's Disease Cuts CVA Cyclic Mastalgia Cyclic Mastitis Cystitis [therapy.epnet.com]

• Constipation

  Tricyclic antidepressants are more likely to cause constipation, weight gain, and sedation than other antidepressants. However, different drugs have different effects. [healthline.com]

  The combination of tricyclics with antihistamines can lead to severe constipation, impacted stools, or difficulty urinating, particularly in older adults. [healthcommunities.com]

  These products are not commonly used as first-line agents for multiple sclerosis-related depression because they can cause some annoying adverse effects such as dry mouth, constipation, bladder problems, sexual dysfunction, blurred vision, dizziness, [sharecare.com]

  Tricyclic antidepressants may cause: blurred vision, dry mouth, constipation, weight gain or loss, low blood pressure on standing, rash, hives, and increased heart rate. [rxlist.com]

  Far more adverse effects were reported in TCA-placebo groups compared with SSRI-placebo groups, e.g. dry mouth (odds ratio [OR] = 3.5; 95% CI 2.9, 4.2); drowsiness (OR = 2.7; 95%CI 2.2, 3.4); constipation (OR= 2.7; 95%CI 2.1, 3.6); sexual problems (OR [ncbi.nlm.nih.gov]

• Nausea

  The crude rates of occurrence of adverse effects ranged from 4% (palpitations) to 26% (nausea) for SSRIs and from 4% (diarrhea) to 27% (dry mouth) for TCAs. [ncbi.nlm.nih.gov]

  Symptoms of abdominal fullness, nausea, abdominal discomfort, and bloating will be graded by the study subject from 0 (none) to 5 (severe). [clinicaltrials.gov]

  Abruptly stopping tricyclic antidepressant treatment can cause: nausea headache dizziness lethargy flu-like symptoms Your doctor will taper your dosage over time to avoid these effects. [healthline.com]

• Diarrhea

  The crude rates of occurrence of adverse effects ranged from 4% (palpitations) to 26% (nausea) for SSRIs and from 4% (diarrhea) to 27% (dry mouth) for TCAs. [ncbi.nlm.nih.gov]

  This slowing down of gut motility makes the TCAs better suited for the treatment of diarrhea-predominant IBS (IBS-D). [verywell.com]

  Sleepiness Weight loss Weight gain Sweating Shaking Issues with your sex life If you take duloxetine, you might have: Nausea Dizziness Fatigue Headaches At first, SSRIs also can make you: Nauseated Dizzy Tired They may also give you: Blurred vision Diarrhea [webmd.com]

  The Sigma-1-selective igmesine (200 mg) showed good results in a phase-1-model of functional diarrhea and some promising results in depressed patients. [dx.doi.org]

• Vomiting

  BACKGROUND: Cyclic vomiting syndrome in adults is a disorder characterized by recurrent and stereotypic episodes of severe nausea and vomiting separated by symptom-free periods. [ncbi.nlm.nih.gov]

  A tricyclic overdose may cause: Hallucinations Drowsiness Enlarged pupils Fever Irregular heartbeat Severe dizziness Severe muscle stiffness or weakness Restlessness or agitation Breathing problems, respiratory failure Vomiting Convulsions Coma A TCA [healthyplace.com]

  Many of the initial signs are those associated to the anticholinergic effects of TCAs such as dry mouth, blurred vision, urinary retention, constipation, dizziness, and emesis (or vomiting). [en.wikipedia.org]

  Symptoms of serotonin syndrome may include anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting, and diarrhea. [rxlist.com]

• Abdominal Pain

  dry eyes, visual changes Diminished sex drive Inflamed tongue Jaundice Hair loss Joint pain, muscle aches, back pain Abdominal pain Palpitations, irregular heartbeat Fever, chills Rash Hiccups Nasal congestion Difficult and/or frequent urination You'll [healthyplace.com]

  Intuniv Side Effects include: Headache Fatigue Abdominal pain Sleepiness and sedation Since Intuniv can cause drowsiness, make sure you know how it affects you before you try driving or operating heavy machinery. [medicinenet.com]

  Adverse effects commonly reported for tricyclics include dizziness, gastrointestinal symptoms (nausea, vomiting, abdominal pain, diarrhoea, dry mouth), headache, lethargy, sleep disturbance. [doi.org]

  Side effects included: dizziness, headache, sweating, drowsiness/lethargy, sleep disturbance/restlessness, apathy/depression, sullenness, tremor, flu, upset stomach/abdominal pain, vomiting/diarrhoea, constipation, dry mouth, rash, nausea, neutropenia [dx.doi.org]

• Xerostomia

  The blockade of these receptors gives as a result: Anticholinergic (atropine-like) effects: blurred vision, xerostomia, urinary retention, constipation and narrow angle glaucoma. [pharmacologycorner.com]

• Hypotension

  Class II agents (beta-blockers) may also precipitate hypotension and cardiac arrest. [ncbi.nlm.nih.gov]

  K+ Channel Blockade QTC Prolongation NE & Serotonin Reuptake Inhibition Initial hypertension quickly followed by hypotension Na+ Channel Blockade QRS Prolongation Hypotension — depresses myocardial contractility Ventricular dysrhythmias Brugada-like findings [em3.org.uk]

• Tachycardia

  A 46-year-old woman presented to the emergency department with coma, hypotension, tachycardia, and a prolonged QRS interval after the ingestion of a large quantity of Elavil. [ncbi.nlm.nih.gov]

  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]

• Hypertension

  A 36-year-old active duty male with migraine headaches presented for evaluation of poorly controlled hypertension. [ncbi.nlm.nih.gov]

  K+ Channel Blockade QTC Prolongation NE & Serotonin Reuptake Inhibition Initial hypertension quickly followed by hypotension Na+ Channel Blockade QRS Prolongation Hypotension — depresses myocardial contractility Ventricular dysrhythmias Brugada-like findings [em3.org.uk]

  Recent emerging concerns regarding use of SSRIs in pregnancy with Neonatal Adaptation Syndrome and a possible association with Persistent Pulmonary Hypertension of the Newborn (PPHN) are likely to lead to increased prescription by clinicians (See SSRI [mothersmatter.co.nz]

  (J Emerg Med 1995;13(6):781-5) This one is from Bryan Hayes) Pharmacologic Effects of TCAs K+ Channel Blockade QTC Prolongation NE & Serotonin Reuptake Inhibition Initial hypertension quickly followed by hypotension Na+ Channel Blockade QRS Prolongation [emcrit.org]

• Muscle Spasm

  The withdrawal symptoms can be very uncomfortable, and they include sweating, tremors, twitching, muscle spasms, seizures, anxiety, nervousness, confusion, agitation, restlessness, nightmares and sleep problems. [anti-depressants.com]

  Nonetheless, there have been reports that women who take these drugs shortly before delivery have given birth to babies who experience muscle spasms and heart, breathing and urinary problems. [drugs.nmihi.com]

  Symptoms of serotonin syndrome may include anxiety, restlessness, sweating, muscle spasms, shaking, fever, rapid heartbeat, vomiting, and diarrhea. [rxlist.com]

  spasms Tips for stopping your antidepressant safely Reduce your dose gradually. [helpguide.org]

  Consider use of a tricyclic antidepressant as a pain adjuvant to promote sleep and alleviate muscle spasm. In appropriately selected patients, consider use of a short- or long-acting opioid or tramadol. [aafp.org]

• Sweating

  Dizziness or lightheadedness Drowsiness Restlessness Racing heartbeat Increased sweating Urinary retention Constipation Tremor Increased appetite Weight gain Low sex drive Difficulty achieving an erection, and other sexual difficulties Low blood pressure [everydayhealth.com]

  Symptoms of withdrawal include; agitation, sweating, headache, malaise, GI upset Interactions Alcohol – together these have an exaggerated depressive effect MAOIs – so never give these drugs together! [almostadoctor.co.uk]

  Some of the more commonly reported side effects with tricyclic antidepressants include: A drop-in blood pressure when moving from a sitting to standing position Blurred vision Constipation Disorientation or confusion Drowsiness Dry mouth Excessive sweating [drugs.com]

  The withdrawal symptoms can be very uncomfortable, and they include sweating, tremors, twitching, muscle spasms, seizures, anxiety, nervousness, confusion, agitation, restlessness, nightmares and sleep problems. [anti-depressants.com]

  Withdrawal symptoms may include insomnia and increased dreaming, and flu-like symptoms such as headache, sweating, chills, nausea or muscular aches. [netdoctor.co.uk]

• Increased Sweating

  Dizziness or lightheadedness Drowsiness Restlessness Racing heartbeat Increased sweating Urinary retention Constipation Tremor Increased appetite Weight gain Low sex drive Difficulty achieving an erection, and other sexual difficulties Low blood pressure [everydayhealth.com]

  Side effects of tricyclic medications The side effects of amitriptyline and nortriptyline include: sedation drowsiness dry mouth (which could contribute to dental decay) blurred vision constipation increased sweating ( hyperhidrosis ) difficultly urinating [dermnetnz.org]

  Other side effects include orthostatic hypotension, weight gain, seizures, bone fractures, sexual dysfunction, increased sweating, and increased or irregular heartbeats. Contraindication TCAs should not be used within 14 days of taking an MAOI. [rxlist.com]

• Behavior Disorder

  […] biological substances T43 ICD-10-CM Diagnosis Code T43 Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified 2016 2017 2018 2019 Non-Billable/Non-Specific Code Type 2 Excludes drug dependence and related mental and behavioral [icd10data.com]

• Urinary Retention

  A rare case of acute urinary retention in a young woman due to simultaneous use of a tricyclic antidepressant and anticholinergic drugs is presented along with the data from the current literature, including the pharmacological action of these drugs, [ncbi.nlm.nih.gov]

  Possible side effects of tricyclic antidepressants include: dry mouth dry eyes blurred vision dizziness fatigue headache disorientation seizure (especially with maprotiline) drowsiness constipation urinary retention sexual dysfunction low blood pressure [healthline.com]

  Be careful using these medicines in people with: Heart problems Epilepsy or lowered seizure threshold (e.g. brain damage) Glaucoma History of urinary retention High thyroid Liver problems Kidney problems Side effects: For many people side effects can [familydoctor.co.nz]

  The blockade of these receptors gives as a result: Anticholinergic (atropine-like) effects: blurred vision, xerostomia, urinary retention, constipation and narrow angle glaucoma. [pharmacologycorner.com]

• Seizure

  Data of patients with seizures due to poisoning were evaluated with respect to the causes, frequencies and complications of seizures. [ncbi.nlm.nih.gov]

• Confusion

  The withdrawal symptoms can be very uncomfortable, and they include sweating, tremors, twitching, muscle spasms, seizures, anxiety, nervousness, confusion, agitation, restlessness, nightmares and sleep problems. [anti-depressants.com]

  Some of the more commonly reported side effects with tricyclic antidepressants include: A drop-in blood pressure when moving from a sitting to standing position Blurred vision Constipation Disorientation or confusion Drowsiness Dry mouth Excessive sweating [drugs.com]

  The patient started with a confused mental state and decreased to a GCS of eight, potentially indicating the need for an advanced airway. [ems1.com]

  Drowsiness Restlessness Racing heartbeat Increased sweating Urinary retention Constipation Tremor Increased appetite Weight gain Low sex drive Difficulty achieving an erection, and other sexual difficulties Low blood pressure when rising to a stand Confusion [everydayhealth.com]

  […] disturbance Tremor and sweating Postural Hypotension – due to α blockade Epileptic fits – even in those with no history of the condition Weight gain – due to appetite stimulation Hyponatraemia – due to inappropriate ADH secretion – this can cause drowsiness, confusion [almostadoctor.co.uk]

• Agitation

  The patient remained agitated for 48 hours after presentation and required frequent sedation. [doi.org]

  Previous case reports describe cognitive-enhancing effects, such as improved arousal, attention, memory, and initiation, of dopaminergic agents, and in the case of tricyclic antidepressants, effects on agitation. [ncbi.nlm.nih.gov]

  The withdrawal symptoms can be very uncomfortable, and they include sweating, tremors, twitching, muscle spasms, seizures, anxiety, nervousness, confusion, agitation, restlessness, nightmares and sleep problems. [anti-depressants.com]

  However, because of this possible link, see your doctor promptly if you become increasingly restless, anxious or agitated, or if you have any suicidal thoughts. [patient.info]

• Tremor

  The withdrawal symptoms can be very uncomfortable, and they include sweating, tremors, twitching, muscle spasms, seizures, anxiety, nervousness, confusion, agitation, restlessness, nightmares and sleep problems. [anti-depressants.com]

  RESULTS: Symptoms reported as side effects to have occurred more frequently and also worsened at week 2 in the group given desipramine included dizziness, dry mouth/thirstiness, lightheadedness, jittery feelings/tremors, and flushing. [ncbi.nlm.nih.gov]

  Symptoms include agitation, confusion, sweating, tremors, and a rapid heart rate The precipitation of a manic episode in people with undiagnosed bipolar disorder An increased risk of seizures in people with a history of seizures An increased risk of arrhythmias [drugs.com]

  […] mood Common Side Effects Tricyclic antidepressants may cause a number of side effects, including: Dry mouth Blurred vision Sweating Dizziness or lightheadedness Drowsiness Restlessness Racing heartbeat Increased sweating Urinary retention Constipation Tremor [everydayhealth.com]

  […] to H1 and α-adrenoceptor blockade, this effect may be useful in some patients to help their sleep pattern, but can be troublesome during the day Antomuscarinic effects – e.g. dry mouth, constipation, urinary retention, impotence, visual disturbance Tremor [almostadoctor.co.uk]

• Hyperactivity

  Multiple agents may be necessary in the successful treatment of some complex attention deficit hyperactivity disorder patients. © Lippincott-Raven Publishers. Related Articles [journals.lww.com]

  In this study, parents and teachers reported that it reduced irritability, hyperactivity, inadequate eye contact and inappropriate speech, but clinician ratings found no significant impact on these symptoms. [cochrane.org]

  They have been used in the treatment of various forms of depression, anxiety disorders, attention deficit hyperactivity disorder and enuresis in children. [randoxtoxicology.com]

  Keywords: attention deficit hyperactivity disorder (ADHD), genes, reward dependence, reward deficiency syndrome, treatment, neuropsychological deficits This work is published and licensed by Dove Medical Press Limited. [doi.org]

  Notably, the TCAs are more effective in treating the behavioral aspects of ADHD than the cognitive deficits, as they help limit hyperactivity and impulsivity, but have little to no benefits on attention. [en.wikipedia.org]

An extensive workup was pursued to evaluate the cause of her mental status, which only revealed a positive urine toxicology screen for TCA. [ncbi.nlm.nih.gov]

• Wide QRS Complex

  After preclinical resuscitation with prolonged external cardiac massage, he was admitted to the intensive care unit with persistently severe hypotension and wide QRS complexes (230-260 ms). [ncbi.nlm.nih.gov]

• Torsades De Pointes

  Torsade de pointes occurs uncommonly. Hypotension results from a combination of reduced myocardial contractility and reduced systemic vascular resistance due to alpha-adrenergic blockade. [ncbi.nlm.nih.gov]

  There may also be a ventricular arrythmia, particularly polymorphic ventricular tachycardia, specifically Torsades de Pointes. This should be treated typically with a magnesium sulfate infusion of 2 g over two minutes. [ems1.com]

• Electrocardiogram Change

  The medications can have deleterious effects on an unhealthy heart, e.g. causing EKG (electrocardiogram) changes or arrhythmias (disturbances in cardiac rhythm or conduction); or, rarely, worsening or precipitating angina or heart failure or precipitating [clusterbusters.org]

Eighty-six patients were treated twice weekly with ECT until recovery or no progress during at least 10 bilateral treatments. Patients were maintained drug free during the ECT treatment. [ncbi.nlm.nih.gov]

Altered mental status in an adolescent presents a diagnostic challenge, and the clinician depends on clinical evaluation and laboratory studies to determine therapy and prognosis. [ncbi.nlm.nih.gov]

Fitzgerald, Is elevated norepinephrine an etiological factor in some cases of Parkinson’s disease?, Medical Hypotheses, 10.1016/j.mehy.2014.01.026, 82, 4, (462-469), (2014). H.P. [doi.org]

The etiology of female breast cancer. Med Principles Pract. 2000; 9 :1–24. [ Google Scholar ] Sharpe CR, Collet JP, McNutt M, Belzile E, Boivin JF, Hanley JA. [ncbi.nlm.nih.gov]

Author information Affiliations Centre for Clinical Epidemiology and Community Studies, Sir Mortimer B. [doi.org]

Epidemiology, Principles and Methods 1996Boston: Little, Brown; 2502nd ed [ Google Scholar ] Marx J. Do antidepressants promote tumors? Science. 1992; 257 :22–23. [ PubMed ] [ Google Scholar ] Miettinen OS. Theoretical Epidemiology. [ncbi.nlm.nih.gov]

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An in vitro study reported that CAs also directly decrease myocardial contractility in a dose-dependent manner. [3] Epidemiology Frequency United States In the 2015 American Association of Poison Control Centers' National Poison Data System Annual report [emedicine.medscape.com]

Pathophysiology The CAs are well absorbed orally and undergo significant first-pass metabolism in the liver. They have a large volume of distribution and have long half-lives that generally exceed 24 hours. [emedicine.medscape.com]

Pharmacotherapy: A Pathophysiologic Approach. From Reviewed by: Marina Katz, MD American Board of Psychiatry & Neurology [rxlist.com]

L Bendtsen, Central sensitization in tension‐type headache—possible pathophysiological mechanisms, Cephalalgia, 20, 5, (486-508), (2001). [doi.org]

A low-dose infusion of ILE was well tolerated and may have successfully prevented recurrent toxicity in a case of severe tricyclic antidepressant overdose. [ncbi.nlm.nih.gov]

Twitter Channel Facebook Profile Pinterest Profile Diseases and Conditions Prevention and Wellness Staying Healthy Healthy Living Travel Occupational Health First Aid and Injury Prevention Crisis Situations Pets and Animals myhealthfinder Food and Nutrition [familydoctor.org]

Cachexia Calcium Oxalate Stones Cancer Prevention (Reducing the Risk) Cancer Treatment Support Candida Candida/Yeast Hypersensitivity Syndrome Canker Sores Car Sickness Cardiac Arrhythmia Cardiac Autonomic Neuropathy, Diabetic Cardiomyopathy Caries, Prevention [therapy.epnet.com]

Prevention of Migraine. American Migraine Foundation. Published September 3, 2014. https://americanmigrainefoundation.org/understanding-migraine/prevention-of-migraine/ Accessed May 11, 2018. Stephen D. Silberstein. Preventive Migraine Treatment. [migraine.com]

TCAs are thought to increase neurotransmitter levels by preventing nerve endings — called synapses — from drawing these chemicals back into their tissues, which is normally how the body reduces their concentrations. [everydayhealth.com]