[Poisoning with antidepressants].

Intoxications with medications are among the most frequent diagnoses in patients admitted to medical emergency departments and intensive care units. Due to their particular toxicity tricyclic antidepressants play an important role despite a decreasing incidence. Tricyclic antidepressant toxicity includes an inhibition of myocardial excitability, central (sedation, seizures) and peripheral anticholinergic signs, and arterial hypotension. Cardiac arrhythmia including ventricular tachycardia and fibrillation, sustained seizures and severe central anticholinergic symptoms such as agitation, delirium, and hyperthermia, are life threatening. Important treatment options include gastrointestinal decontamination with oral single-dose activated charcoal within 1-2 hours post ingestion, and antidotal therapy with boluses of sodium bicarbonate for cardiotoxicity. The selective serotonin reuptake inhibitors (SSRI) and the atypical antidepressants are far less toxic than tricyclics. They may lead to serotonin toxicity (serotonin syndrome).