Novel Presentation of Cardiotoxicity and Other Complications in Tricyclic Antidepressant Poisoning

Abstract

Tricyclic antidepressant (TCA) is a known frequently used and highly potent antidepressant that serves as an unsuspecting source of acute human poisoning. We present a case of an Asian female in her mid-30s who suffered TCA toxidrome that manifested as severe cardiovascular toxicities including arrhythmia characterized by QT elongation that was managed emergently. Hemodynamics and ECG findings improved gradually following appropriate therapy in the intensive care unit. Following two days of treatment, the patient regained consciousness and after seven days the patient made a full clinical recovery and was discharged with no residual neurological effects. The relevant medical literature on TCA poisoning is reviewed.

Self-medication with anxiolytics and antidepressants: main risk factors and repercussions

“…TCA overdose generates cardiotoxicity due to the action of quinidine on cardiac tissues, causing deceleration of the action potential through the conduction system and the myocardium by triggering QRS prolongation and block, contributing to the development of ventricular arrhythmia and refractory hypotension, the former being a common cause of death due to this group of drugs. [39][40][41][42] The drugs Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of drugs that function to block transporters of serotonin or5-hydroxytryptamine (5-HT), a neurotransmitter with a wide range of effects, including the regulation of attention, behavior, memory, thermoregulation, cognition, uterine contraction, gastrointestinal motility, vasoconstriction and bronchoconstriction. SSRIs are responsible for recapturing this molecule in the presynaptic neuronal termination, thus improving neurotransmission.…”

Intento autolítico farmacológico. Diagnóstico y tratamiento. Revisión bibliográfica.

“…Cuando se produce una sobredosis potencialmente mortal comienzan con dosis mayores de 10mg/kg en adultos, los efectos a nivel celular son los siguientes: bloqueo de los canales rápidos de sodio a nivel cardiaco, antagonismo de los receptores muscarínicos centrales y periféricos de acetilcolina, antagonismo de los receptores periféricos alfa 1 adrenérgicos, antagonismo de los receptores de histamina, antagonismo de los receptores ácido gama aminobutíricos A (27).…”