Clinical Pediatric Emergency Medicine
Volume 9, Issue 1 , Pages 24-34 , March 2008

An Update on Antidepressant Toxicity: An Evolution of Unique Toxicities to Master

  • Erica L. Liebelt, MD, FACMT

      Affiliations

    • Corresponding Author InformationReprint requests and correspondence: Erica L. Liebelt, MD, FACMT, 1600 7th Avenue South, Midtown Center 205, Birmingham, AL 35233.

References 

  1. SAMHSA, Center for Mental Health Services (CMHS) 2003: Major Depression in Children and Adolescents Fact Sheet. http://mentalhealth.samhsa.gov/publications/allpubs/CA-0011/default.asp; Accessed 9/3/07.
  2. Weissman MM, Wolk S, Goldstein RB, et al. Depressed adolescents all grown up. JAMA. 1999;12:1707–1713
  3. Delate T, Gelenberg AJ, Simmons VA, et al. Trends in the use of antidepressants in a national sample of commercially insured pediatric patients, 1998-2002. Psychiatr Serv. 2004;55:387–391
  4. Lai MW, Klein-Schwartz W, Rodgers GC, et al. 2005 Annual report of the American Association of Poison Control Centers' national poisoning and exposure database. Clin Toxicol. 2006;44:803–932
  5. Linden CH, Rumack BH, Strehlke C. Monoamine oxidase inhibitor overdose. Ann Emerg Med. 1984;13:1137–1144
  6. Radomski JW, Dursum SM, Reveley MA, et al. An exploratory approach to the serotonin syndrome: an update of clinical phenomenology and revised diagnostic criteria. Med Hypotheses. 2000;55:218–224
  7. Dunkley EJ, Isbister GK, Sibbritt D, et al. The Hunter serotonin toxicity criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003;96:635–642
  8. Livingston MG, Livingston HM. Monoamine oxidase inhibitors. An update on drug interactions. Drug Saf. 1996;14:219–227
  9. Patel S, Robinson R, Burk M. Hypertensive crisis associated with St. John's wort. Am J Med. 2002;112:507–508
  10. Peters RW, Buser GA, Kim HJ, et al. Tricyclic overdose causing sustained monomorphic ventricular tachycardia. Am J Cardiol. 1992;70:1226–1228
  11. Southall DP, Kilpatrick SM. Imipramine poisoning: survival of a child after prolonged cardiac massage. Br Med J. 1974;4:508
  12. Deegan C, O'Brien K. Amitriptyline poisoning in a 2-year old. Pediatr Anesth. 2006;16:174–177
  13. Shannon M, Lovejoy FH. Pulmonary consequences of severe tricyclic antidepressant ingestion. J Toxicol Clin Toxicol. 1987;25:443–461
  14. Popper CW, Ziminitzky B. Sudden death putatively related to desipramine treatment in youth: a fifth case and a review of speculative mechanisms. J Child Adolesc Psychopharmacol. 1995;5:283–300
  15. Varley CK, McClellan J. Case study: two additional sudden deaths with tricyclic antidepressants. Am Acad Child Adolesc Psychiatr. 1997;36:390–394
  16. Biederman J, Baldessarini RJ, Goldblatt A. A naturalistic study of 24-hour electrocardiographic recordings and echocardiographic findings in children and adolescents treated with desipramine. J Am Acad Child Adolesc Psychiatr. 1993;32:805–813
  17. Fletcher SE, Case CL, Sallee FR, et al. Prospective study of the electrocardiographic effects of imipramine in children. J Pediatr. 1993;122:652–654
  18. Catalano G, Catalano MC, Epstein MA, et al. QTc interval prolongation associated with citalopram overdose: a case report and literature review. Clin Neuropharmacol. 2001;24:158–162
  19. Personne M, Sjoberg G, Personn H. Citalopram overdose—review of cases treated in Swedish hospitals. J Toxicol Clin Toxicol. 1997;35:237–240
  20. Blythe D, Hackett LP. Cardiovascular and neurological toxicity of venlafaxine. Hum Exp Toxicol. 1999;18:309–313
  21. White CM, Hailey RA, Levin GM, et al. Seizure resulting from a venlafaxine overdose. Ann Pharmacother. 1997;31:178–180
  22. Howell C, Wilson AD, Waring WS. Cardiovascular toxicity due to venlafaxine poisoning in adults: a review of 235 consecutive cases. Br J Clin Pharmacol. 2007;64:192–197
  23. Paris PA, Saucier JR. ECG conduction delays associated with massive bupropion overdose. J Toxicol Clin Toxicol. 1998;36:595–598
  24. Curry SC, Kashani JS, LoVecchio F, et al. Intraventricular conduction delay after bupropion overdose. J Emerg Med. 2005;29:299–305
  25. Shepherd G, Velez LI, Keyes DC. Intentional bupropion overdoses. J Emerg Med. 2004;27:147–151
  26. Vanpee D, Laloyaux P, Gillet JB. Seizure and hyponatremia after overdose of trazodone. Am J Emerg Med. 1999;17:430–431
  27. Boehnert M, Lovejoy FH. 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;313:474–479
  28. Wolfe TR, Caravati EM, Rollins DE, et al. Terminal 40-ms frontal plane QRS axis as a marker for tricyclic antidepressant overdose. Ann Emerg Med. 1989;18:348–351
  29. Caravati EM, Bossart PJ. Demographic and electrocardiographic factors associated with severe tricyclic antidepressant toxicity. J Toxicol Clin Toxicol. 1991;29:31–43
  30. Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med. 1995;26:195–201
  31. Liebelt EL, Ulrich A, Francis PD, et al. Serial electrocardiogram changes in acute tricyclic antidepressant overdoses. Crit Care Med. 1997;25:1721–1726
  32. Pond SM, Lewis-Driver DJ, Williams GM, et al. Gastric emptying in acute overdose: a prospective randomised controlled trial. Med J Austr. 1995;163:345–349
  33. Gilman PK. The serotonin syndrome and its treatment. J Psychopharmacol. 1999;13:100–109
  34. Lappin R, Auchincloss E. Treatment of serotonin syndrome with cyproheptadine. N Engl J Med. 1994;331:1021–1022
  35. Sasyniuk BI, Jhamandas V. Mechanism of reversal of toxic effects of amitriptyline on cardiac Purkinje fibers by sodium bicarbonate. J Pharmacol Exp Ther. 1984;231:387–394
  36. Blackman K, Brown SF, Wilkes GJ. Plasma alkalinization for tricyclic antidepressant toxicity: a systematic review. Emerg Med. 2001;13:204–210
  37. McCabe JL, Cobaugh DJ, Menegazzi JJ, et al. Experimental tricyclic antidepressant toxicity: a randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate, and hyperventilation. Ann Emerg Med. 1998;32:329–333
  38. 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;230:12–19
  39. McKinney PE, Rasmussen R. Reversal of severe tricyclic antidepressant-induced cardiotoxicity with intravenous hypertonic saline solution. Ann Emerg Med. 2003;42:20–24
  40. Knudsen K, Abrahamsson J. Epinephrine and sodium bicarbonate independently and additively increase survival in experimental amitripytyline poisoning. Crit Care Med. 1997;27:669–674
  41. Knudsen K, Abrahamsson J. Magnesium sulphate in the treatment of ventricular fibrillation in amitriptyline poisoning [letter]. Eur Heart J. 1997;18:881–882
  42. Citak A, Demirkol Soysal D, Ucsel R, et al. Efficacy of long duration resuscitation and magnesium sulphate treatment in amitriptyline poisoning. Eur J Emerg Med. 2002;9:63–66
  43. Goodwin DA, Lally KP, Null DM. Extracorporeal membrane oxygenation support for cardiac dysfunction from tricyclic antidepressant overdose. Crit Care Med. 1993;21:625–627
  44. Williams JM, Hollingshed MJ, Vasilakis A, et al. Extracorporeal circulation in the management of severe tricyclic antidepressant overdose. Am J Emerg Med. 1994;12:456–458

PII: S1522-8401(07)00097-3

doi: 10.1016/j.cpem.2007.11.003

Clinical Pediatric Emergency Medicine
Volume 9, Issue 1 , Pages 24-34 , March 2008