Clinical Features and Management of Self-poisoning with Newer Antidepressants

Over the last decade a number of antidepressants have been introduced which differ either chemically, pharmacologically or toxicologically from established tricyclic and monoamine oxidase drugs. Of those presently available, maprotiline is similar in toxicity to tricyclic antidepressants perhaps causing convulsions more frequently. Lofepramine is metabolised to desmethylimipramine, but the limited clinical experience so far suggests that toxicity is less severe than with other tricyclic antidepressants. Amoxapine causes coma, convulsions and less frequently renal failure, but electrocardiographic abnormalities are uncommon. Mianserin and trazodone both cause drowsiness and more infrequently deeper grades of coma. Alprazolam produces the typical benzodiazepine overdose symptoms of drowsiness and floppiness. There is as yet insufficient clinical data to comment on the specific toxicity of fluoxetine and fluvoxamine. There are many more new antidepressants in various stages of development and it is likely that several of these will be marketed. Since their individual toxicities differ it is essential that monitoring of their overdose effects should be undertaken.