Tricyclic Neuroleptic and Antidepressant Overdose: Epidemiological, Electrocardiographic, and Clinical Features* - A Survey of 92 Cases

Abstract

From 1976 to 1980, there were 3,193 admissions due to acute drug overdosage at the resuscitation centre of the Rudolf-Virchow-Hospital, Free University of Berlin. The frequency and the characteristics of selfpoisoning with antidepressants and low-potency neuroleptic drugs (mainly perazine and thioridazine) were determined. These drugs were involved in 92 cases (3%) during this five-year period. Amitriptyline--in combination with a benzodiazepine--was the most common antidepressant taken by the patients. Ten of the patients required assisted ventilation. Complete ECG recordings were carried out in 24 patients. The most common abnormality was a prolonged QTc interval (21 patients) followed by a QRS duration of 0.11 seconds or longer (17 patients). Sinus tachycardia was present in half of the cases. In no cases did the medical records describe convulsions or cardiac arrhythmias requiring special treatment. The percentage of patients showing ECG changes and respiratory depression was higher when other drugs such as ethanol were ingested along with antidepressants than when only antidepressants were taken. One patient died after six weeks in hospital due to a complicated abscess. From 1976 to 1980, the incidence of antidepressant selfpoisoning was relatively low compared with findings from other studies. Data from other studies suggest that, in the period 1980-1987, there was an increase in the incidence of antidepressant selfpoisoning, at least in the West Berlin and Munich areas. However, these figures are much lower than those reported by British, American, and Australian authors.

Evaluating the risk of QTc prolongation associated with antidepressant use in older adults: a review of the evidence

“…A review of hospitalizations for TCA overdose by Kresse-Hermsdorf and colleagues found the most common adverse effect of a TCA overdose was having a prolonged QT interval. 18…”

“…9 The impact of these agents on the QTc interval is well documented. [11][12][13][14][15][16][17][18][19] The effects of specific agents will be discussed below, and a summary of effects on the QTc interval can be found in Table 2. A self-controlled crossover study conducted by Iribarren and colleagues investigated the effects of drugs known to impact the QT interval.…”

“…A review of hospitalizations for TCA overdose by Kresse-Hermsdorf and colleagues found the most common adverse effect of a TCA overdose was having a prolonged QT interval. 18 Selective serotonin reuptake inhibitors The cardiovascular safety profile of selective serotonin reuptake inhibitors (SSRIs) is a keen topic of research, as these agents are recommended as first-line therapy in the management of geriatric depression. 19 While these agents are generally selected due to their favorable safety profiles, the FDA announced a recommendation to restrict the maximum dose of citalopram in patients aged 60 years and older to 20 mg daily.…”

Letale Intoxikationen mit Antidepressiva und NeuroleptikaAnalyse im Zusammenhang mit den Verordnungen in Wien von 1991 bis 1997

“…Dies mag -analog zu den TCA -an ihrer arrhythmogenen [17] und epileptogenen Wirkung liegen. Thioridazin ist eine besondere Kardiotoxizität nachgesagt worden [5].…”