Clinical Aspects of Tricyclic Antidepressant Poisoning

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Abstract
Self-poisoning with antidepressant drugs was studied retrospectively in 225 patients admitted to an intensive care unit. Amitriptyline accounted for the overwhelming majority of cases (70%); 106 patients (47%) had taken 2 or more drugs, in 81 patients (36%) ethanol was found in the blood. Four (2%) died. On admission, 111 patients (49%) were unconscious (grade III). A further 30 patients (13%) were in grade IV coma, and of these 27 had taken amitriptyline. A total 24 h after admission, 22 patients (10%) remained in coma. Patients [36] (16%) required assisted ventilation. Patients [19] (8%) had convulsions and 6 (3%) aspired stomach contents. Patients [61] (27%) had a widened QRS interval exceeding 100 ms, 18 (30%) of them required assisted ventilation, 21 (34%) were in stage IV coma and 15 (25%) had convulsions. This relationship between a widened QRS interval and the severity of intoxication should be considered in the initial assessment of patients with tricyclic antidepressant poisoning.