Overdose

Because antidepressants are used for depressed patients who are at risk for overdose, the lethality of antidepressant drugs in overdose is of great concern. A tricyclic overdose of 10 times the total daily dose can be fatal (Gram 1990; Rudorfer and Robins 1982). Death most commonly occurs as a result of cardiac arrhythmia. However, seizures and central nervous system depression can occur. Although the use of tricyclics for the treatment of depression has declined, amitriptyline remains widely used for other disorders, such as pain.

The total number of deaths associated with amitriptyline is comparable to that for all other tricyclics and tetracyclics combined. Overdoses often include multiple drugs. In 2006, the American Association of Poison Control Centers (Bronstein et al. 2007) began reporting deaths based on single substance ingestions, which gives a more accurate estimate of lethality. There were 2,730 ingestions of amitriptyline, with 6 deaths, and 1,938 ingestions of all other tricyclic and tetracyclic antidepressants, with 6 deaths. By comparison, there were 19,598 ingestions of various SSRIs, with 3 deaths. The mortality rate for the cyclic antidepressants was 257 per 100,000, while the rate for the SSRIs was 15.3 per 100,000, a 17-fold difference. All of the tricyclic and tetracyclic compounds are dangerous in overdose. Desipramine appears to have a particularly high fatality rate. Amoxapine has been reported to produce high rates of seizure in overdose. But the differences among these drugs are relatively minor in comparison with the improved safety of the second-generation antidepressant agents.

Natural Depression Cures

Natural Depression Cures

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