- Antidepressants are the most commonly prescribed psychiatric medications in U.S.
- Patients who overdose on antidepressants may be on various antidepressants, divided into SSRIs, SNRIs, and atypical. Concomitant usage of atypical antipsychotics and mood-stabilizing medications, some of which are FDA approved for the treatment of depressive disorders, is common
- Antidepressants may be prescribed for multiple other indications, including chronic pain syndromes, anxiety, eating disorders, substance abuse, and sleep disorders
- Tricyclic antidepressants (TCAs) are covered in a separate chapter
- Increase serotonin at the synapse by preventing the reuptake of serotonin by the presynaptic neuron
- SSRIs include paroxetine, fluoxetine, sertraline, citalopram, and escitalopram
- Similar to SSRIs, but also inhibit reuptake of norepinephrine
- Developed because said to have fewer side effects than SSRIs at therapeutic dose, although not true for toxicity
- SNRIs include venlafaxine, desvenlafaxine, and duloxetine
- Atypical antidepressants:
- Have variable effects on serotonin, norepinephrine, and dopamine
- Include mirtazapine, trazodone, and bupropion
- Atypical antipsychotics:
- Most antipsychotics have activity at dopamine receptors, although variable agonism/antagonism depending on medication and dopamine receptor
- Additional activity at serotonin, α-adrenergic, histamine, and muscarinic receptors
- Psychiatric medications also have variable potassium and sodium channel blockade, leading to cardiotoxicity (QT and QRS prolongation, respectively)
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Schaider, Jeffrey J., et al., editors. "Antidepressant Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307497/all/Antidepressant_Poisoning.
Antidepressant Poisoning. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307497/all/Antidepressant_Poisoning. Accessed June 6, 2023.
Antidepressant Poisoning. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307497/all/Antidepressant_Poisoning
Antidepressant Poisoning [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 June 06]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307497/all/Antidepressant_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Antidepressant Poisoning ID - 307497 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307497/all/Antidepressant_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -