Skip to main content
PMC home page
Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2001 Jul;18(4):236–241. doi: 10.1136/emj.18.4.236

Tricyclic antidepressant overdose: a review

G Kerr 1, A McGuffie 1, S Wilkie 1
PMCID: PMC1725608  PMID: 11435353

Abstract

Overdoses of tricyclic antidepressants are among the commonest causes of drug poisoning seen in accident and emergency departments. This review discusses the pharmacokinetics, clinical presentation and treatment of tricyclic overdose.

Full Text

The Full Text of this article is available as a PDF (103.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bailey R. R., Sharman J. R., O'Rourke J., Buttimore A. L. Haemodialysis and forced diuresis for tricyclic antidepressant poisoning. Br Med J. 1974 Oct 26;4(5938):230–231. doi: 10.1136/bmj.4.5938.230-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Banahan B. F., Jr, Schelkun P. H. Tricyclic antidepressant overdose: conservative management in a community hospital with cost-saving implications. J Emerg Med. 1990 Jul-Aug;8(4):451–454. doi: 10.1016/0736-4679(90)90175-u. [DOI] [PubMed] [Google Scholar]
  3. Barnes R. J., Kong S. M., Wu R. W. Electrocardiographic changes in amitriptyline poisoning. Br Med J. 1968 Jul 27;3(5612):222–223. doi: 10.1136/bmj.3.5612.222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Beaubien A. R., Carpenter D. C., Mathieu L. F., MacConaill M., Hrdina P. D. Antagonism of imipramine poisoning by anticonvulsants in the rat. Toxicol Appl Pharmacol. 1976 Oct;38(1):1–6. doi: 10.1016/0041-008x(76)90154-x. [DOI] [PubMed] [Google Scholar]
  5. Bessen H. A., Niemann J. T. Improvement of cardiac conduction after hyperventilation in tricyclic antidepressant overdose. J Toxicol Clin Toxicol. 1985;23(7-8):537–546. doi: 10.3109/15563658508990655. [DOI] [PubMed] [Google Scholar]
  6. Boehnert M. T., Lovejoy F. H., Jr Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants. N Engl J Med. 1985 Aug 22;313(8):474–479. doi: 10.1056/NEJM198508223130804. [DOI] [PubMed] [Google Scholar]
  7. Bosse G. M., Barefoot J. A., Pfeifer M. P., Rodgers G. C. Comparison of three methods of gut decontamination in tricyclic antidepressant overdose. J Emerg Med. 1995 Mar-Apr;13(2):203–209. doi: 10.1016/0736-4679(94)00153-7. [DOI] [PubMed] [Google Scholar]
  8. Brennan F. J. Electrophysiologic effects of imipramine and doxepin on normal and depressed cardiac Purkinje fibers. Am J Cardiol. 1980 Oct;46(4):599–606. doi: 10.1016/0002-9149(80)90509-3. [DOI] [PubMed] [Google Scholar]
  9. Brown T. C., Barker G. A., Dunlop M. E., Loughnan P. M. The use of sodium bicarbonate in the treatment of tricyclic antidepressant-induced arrhythmias. Anaesth Intensive Care. 1973 Feb;1(3):203–210. doi: 10.1177/0310057X7300100302. [DOI] [PubMed] [Google Scholar]
  10. Brown T. C. Tricyclic antidepressant overdosage: experimental studies on the management of circulatory complications. Clin Toxicol. 1976;9(2):255–272. doi: 10.3109/15563657608988129. [DOI] [PubMed] [Google Scholar]
  11. Brown T. C. [Sodium bicarbonate and tricyclic-antidepressant poisoning]. Lancet. 1977 Feb 12;1(8007):375–375. doi: 10.1016/s0140-6736(77)91189-8. [DOI] [PubMed] [Google Scholar]
  12. Brunn G. J., Keyler D. E., Pond S. M., Pentel P. R. Reversal of desipramine toxicity in rats using drug-specific antibody Fab' fragment: effects on hypotension and interaction with sodium bicarbonate. J Pharmacol Exp Ther. 1992 Mar;260(3):1392–1399. [PubMed] [Google Scholar]
  13. Buchman A. L., Dauer J., Geiderman J. The use of vasoactive agents in the treatment of refractory hypotension seen in tricyclic antidepressant overdose. J Clin Psychopharmacol. 1990 Dec;10(6):409–413. doi: 10.1097/00004714-199010060-00005. [DOI] [PubMed] [Google Scholar]
  14. Buckley N. A., Dawson A. H., Whyte I. M., Henry D. A. Greater toxicity in overdose of dothiepin than of other tricyclic antidepressants. Lancet. 1994 Jan 15;343(8890):159–162. doi: 10.1016/s0140-6736(94)90940-7. [DOI] [PubMed] [Google Scholar]
  15. Buckley N. A., O'Connell D. L., Whyte I. M., Dawson A. H. Interrater agreement in the measurement of QRS interval in tricyclic antidepressant overdose: implications for monitoring and research. Ann Emerg Med. 1996 Nov;28(5):515–519. doi: 10.1016/s0196-0644(96)70115-4. [DOI] [PubMed] [Google Scholar]
  16. Buckley N. A., Whyte I. M., Dawson A. H., McManus P. R., Ferguson N. W. Self-poisoning in Newcastle, 1987-1992. Med J Aust. 1995 Feb 20;162(4):190–193. doi: 10.5694/j.1326-5377.1995.tb126020.x. [DOI] [PubMed] [Google Scholar]
  17. Callaham M., Kassel D. Epidemiology of fatal tricyclic antidepressant ingestion: implications for management. Ann Emerg Med. 1985 Jan;14(1):1–9. doi: 10.1016/s0196-0644(85)80725-3. [DOI] [PubMed] [Google Scholar]
  18. Coleridge J., Cameron P. A., Drummer O. H., McNeil J. J. Survey of drug-related deaths in Victoria. Med J Aust. 1992 Oct 5;157(7):459–462. doi: 10.5694/j.1326-5377.1992.tb137307.x. [DOI] [PubMed] [Google Scholar]
  19. Crome P., Adams R., Ali C., Dallos V., Dawling S. Activated charcoal in tricyclic antidepressant poisoning: pilot controlled clinical trial. Hum Toxicol. 1983 Apr;2(2):205–209. doi: 10.1177/096032718300200205. [DOI] [PubMed] [Google Scholar]
  20. Crome P., Dawling S., Braithwaite R. A., Masters J., Walkey R. Effect of activated charcoal on absorption of nortriptyline. Lancet. 1977 Dec 10;2(8050):1203–1205. doi: 10.1016/s0140-6736(77)90440-8. [DOI] [PubMed] [Google Scholar]
  21. Crome P. Poisoning due to tricyclic antidepressant overdosage. Clinical presentation and treatment. Med Toxicol. 1986 Jul-Aug;1(4):261–285. doi: 10.1007/BF03259843. [DOI] [PubMed] [Google Scholar]
  22. Dawling S., Crome P., Braithwaite R. Effect of delayed administration of activated charcoal on nortriptyline absorption. Eur J Clin Pharmacol. 1978 Dec 18;14(6):445–447. doi: 10.1007/BF00716388. [DOI] [PubMed] [Google Scholar]
  23. Emerton D. British poison centres' advice concerning dothiepin overdosage in young children. J Accid Emerg Med. 1997 May;14(3):200–200. doi: 10.1136/emj.14.3.200-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Fasoli R. A., Glauser F. L. Cardiac arrhythmias and ECG abnormalities in tricyclic antidepressant overdose. Clin Toxicol. 1981 Feb;18(2):155–163. doi: 10.3109/15563658108990022. [DOI] [PubMed] [Google Scholar]
  25. Foulke G. E., Albertson T. E. QRS interval in tricyclic antidepressant overdosage: inaccuracy as a toxicity indicator in emergency settings. Ann Emerg Med. 1987 Feb;16(2):160–163. doi: 10.1016/s0196-0644(87)80006-9. [DOI] [PubMed] [Google Scholar]
  26. Freeman J. W., Mundy G. R., Beattie R. R., Ryan C. Cardiac abnormalities in poisoning with tricyclic antidepressants. Br Med J. 1969 Jun 7;2(5657):610–611. doi: 10.1136/bmj.2.5657.610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Freeman J. W., Mundy G. R., Beattie R. R., Ryan C. Cardiac abnormalities in poisoning with tricyclic antidepressants. Br Med J. 1969 Jun 7;2(5657):610–611. doi: 10.1136/bmj.2.5657.610. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Frommer D. A., Kulig K. W., Marx J. A., Rumack B. Tricyclic antidepressant overdose. A review. JAMA. 1987 Jan 23;257(4):521–526. [PubMed] [Google Scholar]
  29. Goldberg M. J., Park G. D., Spector R., Fischer L. J., Feldman R. D. Lack of effect of oral activated charcoal on imipramine clearance. Clin Pharmacol Ther. 1985 Sep;38(3):350–353. doi: 10.1038/clpt.1985.184. [DOI] [PubMed] [Google Scholar]
  30. Goldberg R. J., Capone R. J., Hunt J. D. Cardiac complications following tricyclic antidepressant overdose. Issues for monitoring policy. JAMA. 1985 Oct 4;254(13):1772–1775. [PubMed] [Google Scholar]
  31. Goodwin D. A., Lally K. P., Null D. M., Jr Extracorporeal membrane oxygenation support for cardiac dysfunction from tricyclic antidepressant overdose. Crit Care Med. 1993 Apr;21(4):625–627. doi: 10.1097/00003246-199304000-00025. [DOI] [PubMed] [Google Scholar]
  32. Haemoperfusion in treatment of drug intoxication. Br Med J. 1978 Jan 21;1(6106):174–174. doi: 10.1136/bmj.1.6106.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Hagerman G. A., Hanashiro P. K. Reversal of tricyclic-antidepressant-induced cardiac conduction abnormalities by phenytoin. Ann Emerg Med. 1981 Feb;10(2):82–86. doi: 10.1016/s0196-0644(81)80342-3. [DOI] [PubMed] [Google Scholar]
  34. Hantson P., Benaissa M., Clemessy J. L., Baud F. J. Hyperthermia complicating tricyclic antidepressant overdose. Intensive Care Med. 1996 May;22(5):453–455. doi: 10.1007/BF01712165. [DOI] [PubMed] [Google Scholar]
  35. Heard K., O'Malley G. F., Dart R. C. Treatment of amitriptyline poisoning with ovine antibody to tricyclic antidepressants. Lancet. 1999 Nov 6;354(9190):1614–1615. doi: 10.1016/S0140-6736(99)03358-9. [DOI] [PubMed] [Google Scholar]
  36. Heath A., Wickström I., Mårtensson E., Ahlmén J. Treatment of antidepressant poisoning with resin hemoperfusion. Hum Toxicol. 1982 Oct;1(4):361–371. doi: 10.1177/096032718200100401. [DOI] [PubMed] [Google Scholar]
  37. Henry J. A., Alexander C. A., Sener E. K. Relative mortality from overdose of antidepressants. BMJ. 1995 Jan 28;310(6974):221–224. doi: 10.1136/bmj.310.6974.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Hoffman J. R., Votey S. R., Bayer M., Silver L. Effect of hypertonic sodium bicarbonate in the treatment of moderate-to-severe cyclic antidepressant overdose. Am J Emerg Med. 1993 Jul;11(4):336–341. doi: 10.1016/0735-6757(93)90163-6. [DOI] [PubMed] [Google Scholar]
  39. Hultén B. A., Adams R., Askenasi R., Dallos V., Dawling S., Heath A., Volans G. Activated charcoal in tricyclic antidepressant poisoning. Hum Toxicol. 1988 Jul;7(4):307–310. doi: 10.1177/096032718800700402. [DOI] [PubMed] [Google Scholar]
  40. Hultén B. A., Heath A. Clinical aspects of tricyclic antidepressant poisoning. Acta Med Scand. 1983;213(4):275–278. doi: 10.1111/j.0954-6820.1983.tb03733.x. [DOI] [PubMed] [Google Scholar]
  41. Ilett K. F., Hackett L. P., Dusci L. J., Paterson J. W. Disposition of dothiepin after overdose: effects of repeated-dose activated charcoal. Ther Drug Monit. 1991 Nov;13(6):485–489. doi: 10.1097/00007691-199111000-00003. [DOI] [PubMed] [Google Scholar]
  42. Jarvis M. R. Clinical pharmacokinetics of tricyclic antidepressant overdose. Psychopharmacol Bull. 1991;27(4):541–550. [PubMed] [Google Scholar]
  43. Kingston M. E. Hyperventilation in tricyclic antidepressant poisoning. Crit Care Med. 1979 Dec;7(12):550–551. doi: 10.1097/00003246-197912000-00008. [DOI] [PubMed] [Google Scholar]
  44. Knudsen K., Abrahamsson J. Effects of epinephrine and norepinephrine on hemodynamic parameters and arrhythmias during a continuous infusion of amitriptyline in rats. J Toxicol Clin Toxicol. 1993;31(3):461–471. doi: 10.3109/15563659309000414. [DOI] [PubMed] [Google Scholar]
  45. Knudsen K., Abrahamsson J. Effects of magnesium sulfate and lidocaine in the treatment of ventricular arrhythmias in experimental amitriptyline poisoning in the rat. Crit Care Med. 1994 Mar;22(3):494–498. doi: 10.1097/00003246-199403000-00021. [DOI] [PubMed] [Google Scholar]
  46. Knudsen K., Abrahamsson J. Effects of magnesium sulfate and lidocaine in the treatment of ventricular arrhythmias in experimental amitriptyline poisoning in the rat. Crit Care Med. 1994 Mar;22(3):494–498. doi: 10.1097/00003246-199403000-00021. [DOI] [PubMed] [Google Scholar]
  47. Knudsen K., Abrahamsson J. Epinephrine and sodium bicarbonate independently and additively increase survival in experimental amitriptyline poisoning. Crit Care Med. 1997 Apr;25(4):669–674. doi: 10.1097/00003246-199704000-00019. [DOI] [PubMed] [Google Scholar]
  48. Knudsen K., Heath A. Effects of self poisoning with maprotiline. Br Med J (Clin Res Ed) 1984 Feb 25;288(6417):601–603. doi: 10.1136/bmj.288.6417.601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Kulig K., Bar-Or D., Cantrill S. V., Rosen P., Rumack B. H. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med. 1985 Jun;14(6):562–567. doi: 10.1016/s0196-0644(85)80780-0. [DOI] [PubMed] [Google Scholar]
  50. Kärkkäinen S., Neuvonen P. J. Pharmacokinetics of amitriptyline influenced by oral charcoal and urine pH. Int J Clin Pharmacol Ther Toxicol. 1986 Jun;24(6):326–332. [PubMed] [Google Scholar]
  51. Langou R. A., Van Dyke C., Tahan S. R., Cohen L. S. Cardiovascular manifestations of tricyclic antidepressant overdose. Am Heart J. 1980 Oct;100(4):458–464. doi: 10.1016/0002-8703(80)90657-2. [DOI] [PubMed] [Google Scholar]
  52. Larkin G. L., Graeber G. M., Hollingsed M. J. Experimental amitriptyline poisoning: treatment of severe cardiovascular toxicity with cardiopulmonary bypass. Ann Emerg Med. 1994 Mar;23(3):480–486. doi: 10.1016/s0196-0644(94)70066-4. [DOI] [PubMed] [Google Scholar]
  53. Levitt M. A., Sullivan J. B., Jr, Owens S. M., Burnham L., Finley P. R. Amitriptyline plasma protein binding: effect of plasma pH and relevance to clinical overdose. Am J Emerg Med. 1986 Mar;4(2):121–125. doi: 10.1016/0735-6757(86)90155-5. [DOI] [PubMed] [Google Scholar]
  54. Liebelt E. L., Francis P. D., Woolf A. D. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med. 1995 Aug;26(2):195–201. doi: 10.1016/s0196-0644(95)70151-6. [DOI] [PubMed] [Google Scholar]
  55. Lipper B., Bell A., Gaynor B. Recurrent hypotension immediately after seizures in nortriptyline overdose. Am J Emerg Med. 1994 Jul;12(4):452–453. doi: 10.1016/0735-6757(94)90060-4. [DOI] [PubMed] [Google Scholar]
  56. Marshall J. B., Forker A. D. Cardiovascular effects of tricyclic antidepressant drugs: therapeutic usage, overdose, and management of complications. Am Heart J. 1982 Mar;103(3):401–414. doi: 10.1016/0002-8703(82)90281-2. [DOI] [PubMed] [Google Scholar]
  57. Marshall J. B. Tricyclic overdose. JAMA. 1980 Oct 24;244(17):1900–1900. [PubMed] [Google Scholar]
  58. Mayron R., Ruiz E. Phenytoin: does it reverse tricyclic-antidepressant-induced cardiac conduction abnormalities? Ann Emerg Med. 1986 Aug;15(8):876–880. doi: 10.1016/s0196-0644(86)80666-7. [DOI] [PubMed] [Google Scholar]
  59. McCabe J. L., Cobaugh D. J., Menegazzi J. J., Fata J. Experimental tricyclic antidepressant toxicity: a randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate, and hyperventilation. Ann Emerg Med. 1998 Sep;32(3 Pt 1):329–333. doi: 10.1016/s0196-0644(98)70009-5. [DOI] [PubMed] [Google Scholar]
  60. McMahon A. J. Amitriptyline overdose complicated by intestinal pseudo-obstruction and caecal perforation. Postgrad Med J. 1989 Dec;65(770):948–949. doi: 10.1136/pgmj.65.770.948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Merigian K. S., Woodard M., Hedges J. R., Roberts J. R., Stuebing R., Rashkin M. C. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med. 1990 Nov;8(6):479–483. doi: 10.1016/0735-6757(90)90146-q. [DOI] [PubMed] [Google Scholar]
  62. Molloy D. W., Penner S. B., Rabson J., Hall K. W. Use of sodium bicarbonate to treat tricyclic antidepressant-induced arrhythmias in a patient with alkalosis. Can Med Assoc J. 1984 Jun 1;130(11):1457–1459. [PMC free article] [PubMed] [Google Scholar]
  63. Obafunwa J. O., Busuttil A. Deaths from substance overdose in the Lothian and Borders region of Scotland (1983-1991). Hum Exp Toxicol. 1994 Jun;13(6):401–406. doi: 10.1177/096032719401300606. [DOI] [PubMed] [Google Scholar]
  64. Orr D. A., Bramble M. G. Tricyclic antidepressant poisoning and prolonged external cardiac massage during asystole. Br Med J (Clin Res Ed) 1981 Oct 24;283(6299):1107–1108. doi: 10.1136/bmj.283.6299.1107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Pentel P. R., Benowitz N. L. Tricyclic antidepressant poisoning. Management of arrhythmias. Med Toxicol. 1986 Mar-Apr;1(2):101–121. doi: 10.1007/BF03259831. [DOI] [PubMed] [Google Scholar]
  66. Pentel P. R., Scarlett W., Ross C. A., Landon J., Sidki A., Keyler D. E. Reduction of desipramine cardiotoxicity and prolongation of survival in rats with the use of polyclonal drug-specific antibody Fab fragments. Ann Emerg Med. 1995 Sep;26(3):334–341. doi: 10.1016/s0196-0644(95)70083-8. [DOI] [PubMed] [Google Scholar]
  67. Pentel P., Benowitz N. Efficacy and mechanism of action of sodium bicarbonate in the treatment of desipramine toxicity in rats. J Pharmacol Exp Ther. 1984 Jul;230(1):12–19. [PubMed] [Google Scholar]
  68. Pentel P., Peterson C. D. Asystole complicating physostigmine treatment of tricyclic antidepressant overdose. Ann Emerg Med. 1980 Nov;9(11):588–590. doi: 10.1016/s0196-0644(80)80232-0. [DOI] [PubMed] [Google Scholar]
  69. Pentel P., Sioris L. Incidence of late arrhythmias following tricyclic antidepressant overdose. Clin Toxicol. 1981 May;18(5):543–548. doi: 10.3109/15563658108990281. [DOI] [PubMed] [Google Scholar]
  70. Petit J. M., Spiker D. G., Ruwitch J. F., Ziegler V. E., Weiss A. N., Biggs J. T. Tricyclic antidepressant plasma levels and adverse effects after overdose. Clin Pharmacol Ther. 1977 Jan;21(1):47–51. doi: 10.1002/cpt197721147. [DOI] [PubMed] [Google Scholar]
  71. Ramsay I. D. Survival after imipramine poisoning. Lancet. 1967 Dec 16;2(7529):1308–1309. doi: 10.1016/s0140-6736(67)90420-5. [DOI] [PubMed] [Google Scholar]
  72. Rechlin T. Decreased R-R variation: a criterium for overdosage of tricyclic psychotropic drugs. Intensive Care Med. 1995 Jul;21(7):598–601. doi: 10.1007/BF01700167. [DOI] [PubMed] [Google Scholar]
  73. Ross J. P., Small T. R., Lepage P. A. Imipramine overdose complicated by toxic megacolon. Am Surg. 1998 Mar;64(3):242–244. [PubMed] [Google Scholar]
  74. Saetta J. P., March S., Gaunt M. E., Quinton D. N. Gastric emptying procedures in the self-poisoned patient: are we forcing gastric content beyond the pylorus? J R Soc Med. 1991 May;84(5):274–276. doi: 10.1177/014107689108400510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Sasyniuk B. I., Jhamandas V. Mechanism of reversal of toxic effects of amitriptyline on cardiac Purkinje fibers by sodium bicarbonate. J Pharmacol Exp Ther. 1984 Nov;231(2):387–394. [PubMed] [Google Scholar]
  76. Sasyniuk B. I., Jhamandas V., Valois M. Experimental amitriptyline intoxication: treatment of cardiac toxicity with sodium bicarbonate. Ann Emerg Med. 1986 Sep;15(9):1052–1059. doi: 10.1016/s0196-0644(86)80128-7. [DOI] [PubMed] [Google Scholar]
  77. Scheinin M., Virtanen R., Iisalo E. Effect of single and repeated doses of activated charcoal on the pharmacokinetics of doxepin. Int J Clin Pharmacol Ther Toxicol. 1985 Jan;23(1):38–42. [PubMed] [Google Scholar]
  78. Sener E. K., Gabe S., Henry J. A. Response to glucagon in imipramine overdose. J Toxicol Clin Toxicol. 1995;33(1):51–53. doi: 10.3109/15563659509020215. [DOI] [PubMed] [Google Scholar]
  79. Shannon M., Merola J., Lovejoy F. H., Jr Hypotension in severe tricyclic antidepressant overdose. Am J Emerg Med. 1988 Sep;6(5):439–442. doi: 10.1016/0735-6757(88)90241-0. [DOI] [PubMed] [Google Scholar]
  80. Southall D. P., Kilpatrick S. M. Imipramine poisoning: survival of a child after prolonged cardiac massage. Br Med J. 1974 Nov 30;4(5943):508–508. doi: 10.1136/bmj.4.5943.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  81. Spiker D. G., Biggs J. T. Tricyclic antidepressants. Prolonged plasma levels after overdose. JAMA. 1976 Oct 11;236(15):1711–1712. doi: 10.1001/jama.236.15.1711. [DOI] [PubMed] [Google Scholar]
  82. Starkey I. R., Lawson A. A. Poisoning with tricyclic and related antidepressants--a ten-year review. Q J Med. 1980 Winter;49(193):33–49. [PubMed] [Google Scholar]
  83. Strøm J., Sloth Madsen P., Nygaard Nielsen N., Bredgaard Sørensen M. Acute self-poisoning with tricyclic antidepressants in 295 consecutive patients treated in an ICU. Acta Anaesthesiol Scand. 1984 Dec;28(6):666–670. doi: 10.1111/j.1399-6576.1984.tb02142.x. [DOI] [PubMed] [Google Scholar]
  84. Swartz C. M., Sherman A. The treatment of tricyclic antidepressant overdose with repeated charcoal. J Clin Psychopharmacol. 1984 Dec;4(6):336–340. [PubMed] [Google Scholar]
  85. Swartz C. M., Sherman A. The treatment of tricyclic antidepressant overdose with repeated charcoal. J Clin Psychopharmacol. 1984 Dec;4(6):336–340. [PubMed] [Google Scholar]
  86. Taboulet P., Michard F., Muszynski J., Galliot-Guilley M., Bismuth C. Cardiovascular repercussions of seizures during cyclic antidepressant poisoning. J Toxicol Clin Toxicol. 1995;33(3):205–211. doi: 10.3109/15563659509017985. [DOI] [PubMed] [Google Scholar]
  87. Taylor D. J., Braithwaite R. A. Cardiac effects of tricyclic antidepressant medication. A preliminary study of nortriptyline. Br Heart J. 1978 Sep;40(9):1005–1009. doi: 10.1136/hrt.40.9.1005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  88. Teba L., Schiebel F., Dedhia H. V., Lazzell V. A. Beneficial effect of norepinephrine in the treatment of circulatory shock caused by tricyclic antidepressant overdose. Am J Emerg Med. 1988 Nov;6(6):566–568. doi: 10.1016/0735-6757(88)90092-7. [DOI] [PubMed] [Google Scholar]
  89. Thorstrand C. Clinical features in poisonings by tricyclic antidepressants with special reference to the ECG. Acta Med Scand. 1976;199(5):337–344. doi: 10.1111/j.0954-6820.1976.tb06745.x. [DOI] [PubMed] [Google Scholar]
  90. Thorstrand C. Clinical features in poisonings by tricyclic antidepressants with special reference to the ECG. Acta Med Scand. 1976;199(5):337–344. doi: 10.1111/j.0954-6820.1976.tb06745.x. [DOI] [PubMed] [Google Scholar]
  91. Tokarski G. F., Young M. J. Criteria for admitting patients with tricyclic antidepressant overdose. J Emerg Med. 1988 Mar-Apr;6(2):121–124. doi: 10.1016/0736-4679(88)90151-5. [DOI] [PubMed] [Google Scholar]
  92. Watson W. A., Leighton J., Guy J., Bergman R., Garriott J. C. Recovery of cyclic antidepressants with gastric lavage. J Emerg Med. 1989 Jul-Aug;7(4):373–377. doi: 10.1016/0736-4679(89)90309-0. [DOI] [PubMed] [Google Scholar]
  93. Williams J. M., Hollingshed M. J., Vasilakis A., Morales M., Prescott J. E., Graeber G. M. Extracorporeal circulation in the management of severe tricyclic antidepressant overdose. Am J Emerg Med. 1994 Jul;12(4):456–458. doi: 10.1016/0735-6757(94)90062-0. [DOI] [PubMed] [Google Scholar]
  94. Wrenn K., Smith B. A., Slovis C. M. Profound alkalemia during treatment of tricyclic antidepressant overdose: a potential hazard of combined hyperventilation and intravenous bicarbonate. Am J Emerg Med. 1992 Nov;10(6):553–555. doi: 10.1016/0735-6757(92)90183-x. [DOI] [PubMed] [Google Scholar]

Articles from Emergency Medicine Journal : EMJ are provided here courtesy of BMJ Publishing Group

RESOURCES