Tricyclic antidepressant poisoning

Tricyclic antidepressants are a group of antidepressants named for their chemical structure.

The most common cause of poisoning is accidental ingestion, sometimes with autolytic intent. Excessive ingestion can be toxic and even fatal.

Initially, they may cause confusion, seizures, hallucinations, dry skin and mucous membranes, and urinary retention. After a few hours, more severe complications such as arrhythmias, hypotension, seizures, and coma may occur, requiring urgent hospital consultation and admission and even initial treatment by emergency medical services (EMS).

Diagnosis is based on clinical history and physical examination, confirmed by a blood test.

The patient should be admitted to the hospital for continuous monitoring of vital signs. In the first few hours, gastric lavage may be performed to limit drug absorption, and depending on the severity, supportive care such as intubation may be required. Psychiatric evaluation is always required.