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A Commentary on Treatment of Tricyclic Antidepressant Overdose

Rahul Sawhney and Peter A McCullough

Tricyclic antidepressants are still widely used for depression and other indications today. These drugs have a narrow therapeutic window and can have significant toxicities, with their cardio toxicity being especially striking and potentially fatal. For these reasons, tricyclic antidepressants are a drug of choice for suicide attempts. A key component in the management of tricyclic antidepressant toxicity is the administration of intravenous sodium bicarbonate which has its own potential adverse effects. In this article, we provide a brief commentary on tricyclic antidepressant toxicity, potential treatments, and a brief case vignette to highlight possible morbidity from toxicity treatment itself.