Self-poisonings with tricyclic antidepressants and selective serotonin reuptake inhibitors in Tehran, Iran

Single-Substance SSRI Intoxication: A Clinical and Outcome Profile Presentation in a Poisoning Referal Center

Background: Due to the increasing concern about selective serotonin reuptake inhibitors (SSRIs) poisoning, specifically the risk of serotonin syndrome (SS), and the QT-prolonging effects of certain SSRIs, we evaluated the clinical presentations and outcomes of patients who overdosed on single SSRIs. Methods: We carried out a cross-sectional study at a Poisoning Emergency referal center in Isfahan, Iran, involving 101 patients who had taken a single SSRI drug and were hospitalized between January 2021 and January 2024. Information on demographics, toxicological features, clinical symptoms, electrocardiogram (ECG) findings, and outcomes was gathered. Results: The average age of the patients was 26.98 ± 10.57 years. Females outnumbered males (male to female ratio was 1:3.8). Sertraline was the most frequently ingested SSRI (43.6%), followed by fluoxetine (18.8%). Gastrointestinal symptoms (nausea and vomiting) were the most common clinical signs (n = 30, 29.7%). Six patients (5.9%) were diagnosed with SS. Only one patient experienced a brief, self-limiting seizure after consuming 4 g of sertraline. ECG showed QT interval prolongation (QT prolongation) in 32 patients (31.6%). One patient developed a first-degree AV block after taking 600 mg of citalopram. There was no significant difference in QT prolongation or SS based on the type of SSRI used. All patients survived without complications. Conclusion: This study indicates that overdosing on a single SSRI typically results in mild to moderate clinical manifestations. Cardiac issues, such as QT prolongation, were relatively common among our patients.

Antidepressant Poisoning Trends in Pediatric Intensive Care: A Comparative Study of New- and Old-Generation Antidepressants

PURPOSE/BACKGROUND

This study aimed to compare the frequency, clinical findings, treatment practices, and outcomes of toxicity to old-generation (OG) and new-generation (NG) antidepressants in our pediatric intensive care unit (PICU) by year-to-year.

METHODS/PROCEDURES

The study included patients hospitalized for antidepressant poisoning during the 11-year period of January 2010 through December 2020. Antidepressants were classified as OG and NG. The groups were compared in terms of patient demographic characteristics, type of poisoning (accidental/suicidal), clinical findings, supportive and extracorporeal treatments received, and outcomes.

FINDINGS/RESULTS

The study included 58 patients (NG, n = 30; OG, n = 28). The median age of the patients was 178 months (range, 13.6-215 months) and 47 patients (81%) were female. Patients admitted for only antidepressant poisoning constituted 13.3% of all poisoning cases (58/436). Of these, 22 cases (37.9%) were accidental and 36 (62.3%) were suicidal. The most common cause of poisoning was amitriptyline (24/28) in the OG group and sertraline (13/30) in the NG group. Neurological symptoms were significantly more common in the OG group (76.2% vs 23.8%), while gastrointestinal involvement was more common in the NG group (82% vs 18%; P = 0.001 and P = 0.026, respectively). Old-generation antidepressant poisoning was associated with more frequent intubation (4 vs 0 patients, P = 0.048) and longer length of PICU stay (median, 1 day [range, 1-8] vs 1 day [range, 1-4], P = 0.019). Rates of therapeutic plasma exchange and intravenous lipid emulsion therapy did not differ ( P = 0.483 and P = 0.229, respectively).

IMPLICATIONS/CONCLUSIONS

In poisoned patients, proper evaluation and management of patients requiring PICU admission are vital for favorable patient outcomes.

Effect of intravenous midazolam on cardiac parameters in acute tricyclic antidepressants poisoning

BACKGROUND

Midazolam is commonly and safely used in poisoning management and intensive care for the control of agitated poisoned patients. Despite the introduction of newer and safer antidepressants, tricyclic antidepressants (TCAs) are still prescribed and used in many countries due to their cost-effectiveness. Severe morbidity and mortality associated with these drugs arises largely from their well-documented cardiovascular toxicity. In this study we aimed to investigate the probable effect of midazolam on some hemodynamic indices in TCAs-poisoned patients.

METHODS

In this clinical trial, we have evaluated some cardiovascular and hemodynamic indices of 100 TCAs-poisoned patients whom were randomly allocated for receiving midazolam with a first loading dose of 0.1 mg/kg (2 mg/minute) followed by a 6-hour maintenance infusion of 0.1 mg/kg/h of the drug in dextrose-saline (3.33% of dextrose and 0.33% of NaCl) or placebo (dextrose-saline infusion without midazolam). Pulse rate, systolic/diastolic blood pressure, respiratory rate, neurologic status and the outcome of therapy for all patients were recorded at the time of admission and hourly for the next 6 hours.

RESULTS

There was a statistically significant reduction in the heart rate of the midazolam treated group after the first hour of hospital admission. There were no significant differences in the respiratory rate, central nervous system manifestations and other indices between the two groups.

CONCLUSION

Midazolam may reduce tachycardia (and its fatal consequences) in the first hour of admission in TCAs-poisoned patients.

Tricyclic antidepressants intoxication in Tehran, Iran: epidemiology and associated factors

BACKGROUND

Tricyclic antidepressant (TCA) intoxication contributes a large number of drug toxicities with serious complications. There are a few studies about factors associated with TCA intoxication. This study therefore aimed to identify determinants of this type of intoxication.

METHODS

A cross-sectional study was carried out at Loghman-Hakim Poison Hospital during a 6-month period. All poisoned patients aged >12 years presented to this hospital during the mentioned period were evaluated. Then, TCA-poisoned patients were compared with other drug intoxications as the control group to determine factors associated with TCA intoxications.

RESULTS

There were 9809 admissions, of which 1583 (16.1%) patients including 601 (38%) males were intoxicated with TCAs. Mean age of the subjects was 26.5 + 10 years. Most of the TCA intoxications (74.4%) were intentional (p = 0.01). Amitriptyline was the most frequent agent followed by Nortriptyline. There was no significant difference between TCA and non-TCA intoxications regarding the mortality (1.3% in TCA vs. 1.1% in others, p = 0.45). Logistic regression analysis revealed that sex, addiction status, and history of psychological problems have association with TCA intoxication.

CONCLUSIONS

The results of this study are helpful in identifying individuals who are prone to TCA intoxication and may be useful in implementation of preventive strategies.