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The antidepressant effect of these drugs is based on the reduction of inhibition of mental activities without agitation, in patients with depression they improve mood, while at the same time rather calming down.
Cyclic antidepressants have a relatively low therapeutic index and, when overdosed, are potentially life-threatening. Acute poisoning with these drugs is the cause of more than 26% of all deaths registered in toxicological information centers in the USA. Therefore, pharmaceutical companies are trying to produce a new generation of cyclical antidepressants, effective and less toxic.
Tricyclic antidepressants
Tricyclic antidepressants (TCAs) are the most commonly prescribed antidepressants, accounting for 91% of overdoses in this class of drugs, and accounting for 84% of deaths from antidepressant drug poisoning in general. They are the most toxic antidepressants in use today. These drugs are quickly absorbed. Sudden loss of consciousness and severe symptoms of poisoning are often observed, usually within 60 minutes of ingestion.
Do a short test to see if you may be depressed
Four-cycle antidepressants
Maprotiline is a representative of the drugs from the group of four-cyclic antidepressants. The toxic effect of an overdose is analogous to that of an overdose of TCA. Convulsions, however, occur much more frequently.
Dibenzoksazepiny
Two drugs from this group are commercially available: amoxapine and loxapine, but only amoxapine has antidepressant properties. Despite the structural similarities of amoxapine to TCA, it shows less toxicity to the cardiovascular system (no arrhythmias or sinus tachycardia are observed, hypotension rarely occurs, and if it does, it is less pronounced). Seizures are more common than with TCA. They appear in 20–50% of poisoning cases.
Bicyclic antidepressants
These include trazodone and fluoxetine, among others. Their antidepressant effect is to delay the uptake of serotonin. The simultaneous only slight effect on the adrenergic nervous system means that these drugs do not have toxic effects on the cardiovascular system. Only somnolence and slight anticholinergic symptoms are observed with trazodone overdose.
In case of overdose with the substance of fluoxetine, slight anticholinergic symptoms (nausea, vomiting) are observed. Cardiovascular toxicity has not been reported. Fluoxetine and its active metabolite, norfluoxetine, are excreted in human milk. Their impact on newborns is not yet fully understood. Animal studies have shown no harmful effect of the preparation containing fluoxetine on the fetus. This drug reduces appetite and thus contributes to the reduction of excess weight.
Symptoms of poisoning
A dose of 40-80 mg causes no side effects, and if anything, symptoms are minimal. Taking 1 to 3 g may cause convulsions, visual disturbances and vomiting. Sometimes ST segment depression is observed. Tachycardia only occurs when anticholinergics are taken concomitantly.
First aid
As in poisoning with neuroleptic drugs.