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Cyclic Antidepressants
The clinical presentation of poisoning from cyclic antidepressants varies widely because of complex pharmacologic factors.
Causes
- Cyclic antidepressants as a result of dysrhythmias, alpha-adrenergic blockade, cardiac conduction abnormalities and direct myocardial depression, autonomic neuron neurotransmitter depletion, and capillary leakage.
- Cyclic antidepressants may occur due to blockade of H1-histamine, muscarinic cholinergic, GABA, and NMDA-glutamate receptors, neuronal fast sodium channel blockade, and reuptake blockade of monoaminergic neurotransmitters.
- Cyclic antidepressants may also cause due to muscarinic anticholinergic effects.
Symptoms
- Lethargy to coma, seizures
Signs
- Mydriasis (anticholinergic) or miosis (alpha-adrenergic blockade)
- Dry skin
- Tachycardias
- Lethargy to coma
- Seizures
- Agitated delirium (occasionally)
- Hypotension
- Hypertension (mild, early)
Treatment
- For the treatment of cyclic antidepressants, Sodium bicarbonate is the first-line therapy and we will used first-line therapy when TCA ingestion is known or strongly suspected.
- In which method, Treatment consists of three stages, Acute treatment that aimed to relieving the depressive symptoms. Because medication may take a few weeks to start working, so it is important to keep taking it as scheduled.
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