Is tricyclic antidepressant poisoning dangerous?

Tricyclic antidepressants are a group of drugs with properties that help treat depression, neuralgia, migraines, bed-wetting, and attention deficit hyperactivity disorder. Due to the nature of long-term treatment as well as poor compliance of subjects participating in drug abuse treatment, it is easy to lead to drug poisoning, seriously affecting the health and life of patients.

Toxic effects on the cardiovascular and central nervous system are the main complications of the abuse of tricyclic antidepressants. Most of the time, tricyclic antidepressants poisoning is acute poisoning, clinically difficult to predict and can turn critical very quickly within a few hours after being taken to the emergency room. Specifically:
1.1. For cardiovascular toxicity This is the main cause of complications and death in poisoning with tricyclic antidepressants:
Patient presents with hypotension unresponsive to treatment due to muscle depression heart rate, hypoxemia, acidosis, volume depletion, convulsions. The most common arrhythmia is sinus tachycardia (120-160 beats/min in adults) present in most patients with tricyclic antidepressants overdose. The electrocardiogram, which often shows delayed intraventricular conduction, can be used to identify and stratify the risk in patients with toxicity. Tachycardia and wide QRS complexes are features of critical arrhythmias in patients with severe toxicity.

1.2. For CNS toxicity The main manifestations are disturbances of consciousness and convulsions, specifically:
Delirium, agitation and behavioral disturbances with hallucinations may appear due to the antimuscarinic effect and histminergic. Often the patient will then appear somnolent and rapidly progress to coma. Convulsions are usually generalized and brief, occurring within 1-2 hours after taking the drug. A few minutes after convulsion the patient may experience sudden hemodynamic disturbances, namely hypotension and ventricular arrhythmias. The risk of seizures from an overdose of tricyclic antidepressants may be increased in patients with prior long-term treatment or in those with risk factors such as a history of seizures, traumatic brain injury, etc. Dyskinesia and extrapyramidal symptoms may also occur 1.2. For respiratory toxicity Acute lung injury may result from the vasoconstrictor and bronchospasm effects associated with overdose. Substances that cause acute lung injury can result from aspiration, hypotension, pulmonary infection, volume overload, and primary toxic effects from antidepressants. 1.3. For anticholinergic effect Pupils may dilate and reflect poorly on light Dry mouth, dry red skin, urinary retention and bowel obstruction

Typical symptoms of tricyclic antidepressant toxicity such as sinus tachycardia, slurred speech, and lethargy. In the late stage, the patient may have other signs such as lethargy, coma, convulsions, hypotension, arrhythmia.

The most important thing to do to stabilize the patient after taking poisoned drugs, including management according to ABC (airway, breathing capacity and circulation) as well as supportive treatment. After stabilization, the gastrointestinal tract should be decontaminated by gastric lavage. Accordingly, it is necessary to wash a lot with more than 20 liters of water. Next will be activated charcoal along with a bleach.
In often dilated QRS complexes, infusion of lactate salts is often effective and the characteristic value. In addition, supportive cardiovascular care should be initiated early, patients with respiratory failure need mechanical ventilation. In case of hypotension, intravenous fluids must be given (with caution in patients with heart failure).
Poisoning with tricyclic antidepressants is very dangerous, can seriously affect the health and life of the patient. Therefore, the use of tricyclic antidepressants to treat the disease should strictly follow the doctor's instructions, avoid abuse and overdose.