Antidepressant Toxicity Follow-up

  • Author: Jeena Jacob, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Feb 8, 2010
 

Further Inpatient Care

  • Patients being treated for antidepressant toxicity may need repeat boluses of bicarbonate or drip and will require cardiac monitoring and ICU care if admitted.
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Complications

Complications of antidepressant toxicity may include the following:

  • CNS sequelae
  • Seizures
  • Dysrhythmias
  • Hypotension
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Prognosis

  • Prognosis generally is favorable without long-term CNS or cardiovascular sequelae in patients who survive initial toxicity. Most fatalities occur within the first 24 hours; survival beyond this time suggests a favorable prognosis unless severe hypoxia or hypotension were present before initial treatment.
  • A small subset may have prolonged neurologic sequelae after status seizures or persistent hypotension.
  • Patients who remain asymptomatic following 6 hours of emergency department observation are unlikely to develop toxicity.
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Patient Education

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Contributor Information and Disclosures
Author

Jeena Jacob, MD  PharmD, Medical Toxicology Fellow, Rocky Mountain Poison and Drug Center, Denver, CO

Jeena Jacob, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Theodore I Benzer, MD, PhD  Assistant Professor in Medicine, Harvard Medical School; Director of Clinical Operations, Director of Toxicology, Chair of Quality and Safety, Department of Emergency Medicine, Massachusetts General Hospital

Theodore I Benzer, MD, PhD is a member of the following medical societies: Alpha Omega Alpha and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

David C Lee, MD  Research Director, Department of Emergency Medicine, Associate Professor, North Shore University Hospital and New York University Medical School

David C Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD  Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Eric Legome, MD, and Craig Smollin, MD, to the development and writing of this article.

References

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Toxicity, antidepressant. ECG shows the terminal R wave in aVR and the widened QRS complex associated with tricyclic antidepressant (TCA) toxicity.
 
 
 
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