title: Cyclic antidepressant overdose in children: a proposed treatment protocol.
abstract: Cyclic antidepressant overdose is a major cause of drug overdose deaths and morbidity in the United States. The cyclic antidepressants are prescribed widely by primary care physicians and psychiatrists, and accidental overdose in children is not uncommon. Children have exhibited toxic effects with relatively small amounts of cyclic antidepressants. The management of cyclic antidepressant overdose is difficult because of the complex effects on the cardiovascular and nervous systems. The pertinent pharmacology of cyclic antidepressants in therapeutic amounts and in overdose is reviewed in this article. The clinical manifestations of cyclic antidepressant overdose are described. A protocol for effective management of cyclic antidepressant overdose in children is proposed.
mesh_terms: D000042:Absorption; D000109:Acetylcholine / Q000037:antagonists & inhibitors; D000929:Antidepressive Agents, Tricyclic / Q000378:metabolism / Q000494:pharmacology / Q000506:poisoning*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D001341:Autonomic Nervous System / Q000187:drug effects; D001639:Bicarbonates / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D007223:Infant; D007486:Ipecac / Q000627:therapeutic use; D008297:Male; D009638:Norepinephrine / Q000378:metabolism / Q000627:therapeutic use; D010672:Phenytoin / Q000627:therapeutic use; D010830:Physostigmine / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D012964:Sodium / Q000627:therapeutic use; D017693:Sodium Bicarbonate; D014018:Tissue Distribution
chemical_list: D000929:Antidepressive Agents, Tricyclic; D001639:Bicarbonates; D010672:Phenytoin; D007486:Ipecac; D017693:Sodium Bicarbonate; D012964:Sodium; D010830:Physostigmine; D000109:Acetylcholine; D009638:Norepinephrine