Barbey J T, Roose S P
Division of Clinical Pharmacology, Georgetown University Medical Center, Washington, DC, USA.
J Clin Psychiatry. 1998;59 Suppl 15:42-8.
The morbidity and mortality caused by tricyclic antidepressant (TCA) overdose are well recognized. Among newer antidepressants, the selective serotonin reuptake inhibitors (SSRIs) are thought to be safer in overdose. This study was designed to describe the signs, symptoms, and mortality associated with SSRI overdose.
English-language articles identified through MEDLINE (1985 through 1997), and case reports from the American Association of Poison Control Centers (AAPCC) (1987 through 1996) and United States Food and Drug Administration (FDA) adverse event database (through 1997) that describe findings of fatal and nonfatal overdoses involving SSRIs alone or in combination with other ingestants were reviewed.
SSRI antidepressants are rarely fatal in overdose when taken alone. During the 10 years that SSRI antidepressants have been marketed, there have been remarkably few fatal overdoses reported in the literature or to the AAPCC or FDA involving ingestion only of an SSRI. Moderate overdoses (up to 30 times the common daily dose) are associated with minor or no symptoms, while ingestions of greater amounts typically result in drowsiness, tremor, nausea, and vomiting. At very high doses (> 75 times the common daily dose), more serious adverse events, including seizures, electrocardiogram (ECG) changes, and decreased consciousness may occur. SSRI overdoses in combination with alcohol or other drugs are associated with increased toxicity, and almost all fatalities involving SSRIs have involved coingestion of other substances.
The SSRI antidepressants are far safer than the TCAs in overdose. There is no apparent difference among SSRIs with respect to overdose safety.
三环类抗抑郁药（TCA）过量导致的发病率和死亡率已得到充分认识。在新型抗抑郁药中，选择性5-羟色胺再摄取抑制剂（SSRI）被认为在过量服用时更安全。本研究旨在描述与SSRI过量相关的体征、症状和死亡率。
回顾通过MEDLINE（1985年至1997年）检索到的英文文章，以及美国毒物控制中心协会（AAPCC）（1987年至1996年）和美国食品药品监督管理局（FDA）不良事件数据库（截至1997年）中的病例报告，这些报告描述了单独使用SSRI或与其他摄入物联合使用时致命和非致命过量服用的结果。
单独服用SSRI抗抑郁药过量很少致命。在SSRI抗抑郁药上市的10年中，文献中、向AAPCC或FDA报告的仅摄入SSRI的致命过量服用案例非常少。中度过量（高达常用日剂量的30倍）与轻微症状或无症状相关，而摄入量更大时通常会导致嗜睡、震颤、恶心和呕吐。在非常高的剂量（>常用日剂量的75倍）下，可能会发生更严重的不良事件，包括癫痫发作、心电图（ECG）改变和意识下降。SSRI与酒精或其他药物联合过量服用会增加毒性，几乎所有涉及SSRI的死亡都涉及同时摄入其他物质。
在过量服用时，SSRI抗抑郁药比TCA安全得多。在过量服用安全性方面，SSRI之间没有明显差异。
