Antidepressant Overdose: An Updated Review on Diagnosis and Outcome

Background: Antidepressant drugs are among the most commonly encountered causes of self-poisoning. These drugs include tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), atypical antidepressants, and N-methyl-D-aspartate receptor (NMDA) antagonists. Cardiac toxicity is one of the major concerns with antidepressant drugs. TCAs are generally more toxic in overdose, while MAOIs and SSRIs are relatively nontoxic when taken alone. Overdoses of combinations of MAOIs and either SSRIs or TCAs with serotonin reuptake blocking activity may result in a serotonin syndrome. This work aimed to give an overview of the clinical management of antidepressant drug overdose with respect to the role of cardiac biomarkers in improving the outcome of toxicity, and new trials of treatment. Conclusion: Cardiotoxicity is the main cause of morbidity and mortality of antidepressant drugs poisoning. Cardiac biomarkers may have a role in predicting early cardiac complications in antidepressants. In the absence of a specific antidote, sodium bicarbonate is still considered the treatment of choice for severe toxicity, although a variety of supportive measures may be taken. Searching for new lines of therapy is recommended to improve the outcome of antidepressant drugs overdose.