These are the Agents or Drugs used to treat

depression
 It is characterized by feeling of intense sadness &
despair, slowing of thought process, impaired
concentration, constant worry and agitation of
self deprecation.
 It is the commonest mental illness world-wide.
1. Nor-epinephrine reuptake inhibitors or cyclic anti depressants
a. Tertiary amine tri cyclic,
Ex. Imipramine, Clomipramine
b. Secondary amine tri cyclic,
Ex. Desipramine, Nortryptyline
2. Selective serotonin reuptake inhibitors
Ex. Duloxetine, Fuloxetine
3. Monoamine oxidase inhibitors
Ex. Isocarboxacide, Iproniazid
4. Atypical anti depressants
Ex. Bupropion, Trazodone
 Depression
 Social phobia
 Attention deficit
 Childhood enuresis
The toxicity of cyclic antidepressants is mainly
due to effects on myocardium CNS and
peripheral vasculature.
 Seizures, hallucination, confusion and coma
 Anti cholinergic effects like mydriasis,
tachycardia, urinary retention and decreased GI
motility
 Neuroleptic malignant syndrome
 Myocardial infraction
 Patients with ECG changes should be monitored in the ICU until the
mental status is baseline, the patient is asymptomatic and EGC has
returned to normal for 24 hrs.

 Supportive measures:
a. Maintain airway: intubate if indicated
b. Monitor arterial blood gases
c. Administer Oxygen if necessary
d. Treat hypotentension with IV cystalloids, inotropes (dopomine),
Vasopressors (Noradrenaline) etc
 Reduce drug absorption:
a. Stomach wash (with in first 6 hrs)
b. Activated charcoal ( 1gm/kg)
 Enhance drug elimination:
a. Multiple dose activated charcoal
b. Haemoperfusion is not routinely recommended, but has been used in
patients with severe intoxication
 Treat Convulsions:
a. Diazepam 0.1 mg/kg IV
b. Phenytoin 15 mg/kg IV infusion
 Treat Arrhythmias:
a. Serum alkalinisation to a pH 7.45 to 7.55 using intra venous boluses of
Sodium Bicarbonate.
b. Anti- arrhythmias -> Quinidine, Disopyramide and procianamide
c. Supra ventricular arrhythmias -> Alkalinise (to 7.40 – 7.45 ph)
synchronized cardio version if alkalinasation is ineffictive
Ex. Sodium bicarbonate 1 to 2 mEq/kg
d. Ventricular tachycardia – alkalinise (to 7.40 -7.45 ph) lignocane 1mg/kg
IV, bolus, followed by infusion of 2 to 4 mg/min
e. Ventricular fibrillation – defibrillate with sodium bicarbonates 1 to 3
numol/kg
f. Brady cardia or heart block – isoprenaline
g. Use of physostigmine, But it is not recommended except to treat life
threatening symptoms
h. Flumazenil has been associated with the onset of reizures and ventricular
arrhythmias
 Depression
 Migraine
 Panic disorder
 Sleep disorder
Overdose of SSRI results in
 Abdominal pain
 Nausea
 Vomiting
 CNS depression
 Serotonin syndrome
 Diarrhea
 Vertigo
 Insomnia
 Tremors
 Paroxetine exposure in utero, with maternal doses has resulted in a neonatal
syndrome with effects including vomiting, irritability, hypoglycemia and
necrotizing enterocolitis.
 Sodium bicarbonate may be useful in treating
QRS prolongation of arrhythmias
 Haemodialysis
 Forded Dieresis
 Haemoperfusion
 Monitoring for evidence of Serotonin syndrome
 Depression
 Anxiety disorders
 Phobic disorders
 Parkinson’s disease
Overdose of MAOI’s results in
 Anxiety
 Headache
 Nausea
 Hyperthermia
 Convulsion
 Delirium
 Respiratory Depression
 Hallucination
 Tremors
 Cardio vascular collapse
 In some cases it leads to death
 Overdose complicated by hypotension often leads to myoglobinusia,
acute tubular necrosis and renal failure.
 Maintenance of airway, Oxygen, assisted ventilation, etc..
 Cardiac Monitoring
 Electrolytes should be monitored, particularly for hyperkalaemia
 Monitor liver and renal function
 Severe hypertension should be treated with IV sodium nitroprusside
 Seizures -> Benzodiazepines/barbiturates
 Hypotention/shock can be managed by IV fluids and vasopressors such as
nor adrenaline or dopamine
 Ventricular tachyarrhythmia's -> lignocain, phenytoin
 Gut decontamination- lavage, activated charcoal, cathartics
 Deficit disorder
 Depression
 Ataxia
 Dystonia
 Hypomania
 Convulsions
 Hallucination
 Tremor
 Bupropion during pregnancy has been associated with increased incidence
of spontaneous abortion
 Control of convulsions- IV diazepam, phenytoin
 Cardiac monitoring
 Obtain serum electrolytes
 Monitor for seizures and mental status changes