Depression is extremely common these days. Therefore, many people have to regularly take special medications - antidepressants. But when using such drugs, great care must be taken. This group of medicines includes amitriptyline-based products. Poisoning with these drugs most often occurs due to an overdose of tablets. How to recognize intoxication? And how to help the victim? We will answer these questions in the article.
General description of the drug
Amitriptyline is an active component of the tricyclic antidepressants of the old generation. These drugs are quite effective, so they are still used in medicine.
Most often, drugs with this substance are produced under the same name - "Amitriptyline". Less common are the trade names Saroten and Tryptisol.
Amitriptyline blocks the capture by the nerve cells of the “hormones of joy” - serotonin and norepinephrine. As a result, these substances accumulate in the body. The person disappears anxiety and longing, and the mood improves.
However, this medicine does not work instantly. The antidepressant effect can be felt only after 10-14 days. During this time, its active component accumulates in the body. There are cases when patients, not feeling the instant effect in the first days of treatment, arbitrarily increase the dose of the drug. This can lead to amitriptyline poisoning.
Depression is the main, but not the only indication for the appointment of this remedy. The drug is also used to treat bulimia and anorexia, intestinal irritation and urinary incontinence in children.
This antidepressant is a strictly prescription drug. In no case should you take it yourself. The entire course of treatment should be supervised by a doctor.
Causes of intoxication
Why does amitriptyline poisoning occur? Most often, the cause of intoxication is a violation of the rules for taking the medicine:
- Overdose. There are times when patients independently increase the daily number of tablets.
- Drinking alcohol during treatment. Doctors categorically forbid drinking alcohol while taking antidepressants. Ethanol enhances the effects of psychotropic drugs. This combination dramatically depresses the nervous system.
- Taking other medications that are poorly compatible with antidepressants. Such drugs include sleeping pills, antipsychotics, and anticonvulsants. This combination of drugs can also lead to poisoning.
In psychiatric practice, there have been cases of drug poisoning for the purpose of suicide. After all, this medicine is often prescribed for depression, and such a mental state can be accompanied by suicidal ideas. Therefore, patients with a tendency to suicide should be treated with antidepressants in a hospital.
Amitriptyline poisoning is also observed among children. Some forms of these tablets are available as dragees. A child can take them for sweet vitamins and accidentally drink. Therefore, such a potent medicine should be hidden from children as far as possible.
Dangerous dosage
This antidepressant is available in 25 mg tablets. The required dose of medication can only be selected by a doctor. The entire course of treatment is under the supervision of a specialist. When the condition improves, the number of tablets is reduced, and if it worsens, they are increased.
The recommended dose should never be exceeded. Even when taking 6 tablets in adults, signs of mild intoxication appear. A dangerous dose for children is even less. A child can get poisoned by accidentally drinking 3-4 tablets.
If the patient simultaneously took 1.5 grams of the drug (60 tablets), then this leads to death. Even if the patient took a lethal dose in several doses per day, it still poses a huge danger to life.
How does intoxication develop?
Consider the pathogenesis of amitriptyline poisoning. After taking a large number of tablets, the active component is rapidly absorbed into the blood. A huge concentration of serotonin and norepinephrine accumulates in the body. This leads to a strong overexcitation of the nervous system, the appearance of hallucinations and seizures. Subsequently, this condition is replaced by a sharp inhibition of brain functions and loss of consciousness, up to a coma.
This antidepressant also has anticholinergic effects. Therefore, the patient's pupils dilate sharply, shortness of breath appears, an unpleasant dry mouth appears. With a significant excess of the permissible dose, the drug inhibits respiration and cardiac activity. This often leads to death.
The ICD-10 code for amitriptyline poisoning is T.34. This cipher encodes intoxication with psychotropic drugs, not classified elsewhere.
In medicine, three degrees of intoxication are distinguished. We will consider the signs of poisoning depending on the severity of the patient's condition.
Mild
Mild intoxication occurs with a small overdose. For example, a patient took two tablets instead of one, or took the entire daily dose once. In this case, the following symptoms of amitriptyline poisoning appear:
- Excitation. There is motor and mental anxiety. The patient becomes restless, irritable and aggressive.
- Disorders of excretory function. Frequent urination appears, sometimes involuntary.
- Visual impairment. Due to the expansion of the pupils, the patient does not see well. All surrounding objects seem to him fuzzy and vague.
Such an easy option of intoxication usually has a good prognosis. After a few days, the patient recovers. Complications in most cases are not noted.
Moderate poisoning
Medium poisoning occurs with a more significant excess of the dose. Such intoxication also occurs when the drug is combined with alcohol or potent psychotropic drugs. This condition is accompanied by the following symptoms:
- Severe drowsiness. The patient may suddenly fall asleep in any position.
- Mental disorders. In some cases, visual and auditory hallucinations occur.
- Inhibition. The patient looks lethargic, his movements are slow and poorly coordinated. Speech becomes fuzzy.
- Hyperthermia. The patient develops a fever (up to 38 degrees).
- Disorders of cardiovascular activity and respiration. Strong tachycardia occurs, and blood pressure drops. The patient is heavy and often breathes.
- Dyspeptic phenomena. The patient is concerned about nausea and vomiting.
With moderate poisoning, the prognosis worsens. If the patient is not helped on time, then he may lose consciousness and fall into a coma.
Severe degree
Severe intoxication occurs when the therapeutic dose of an antidepressant is exceeded many times. The clinic of amitriptyline poisoning with a deadly overdose is as follows:
- loss of consciousness;
- coma;
- lack of reaction of pupils to light stimuli;
- a sharp drop in blood pressure;
- frequent weak pulse;
- bouts of seizures.
This is an extremely serious condition. Without treatment, it inevitably leads to death.
How to help a patient
At home, it is impossible to cure poisoning with an antidepressant. Therefore, you must immediately call an ambulance crew. The faster the doctors begin to treat the patient, the greater the chances of saving the patient.
If the victim is conscious, then at the pre-medical stage he needs to be given the following help:
- Rinse the stomach with a weak solution of potassium permanganate.
- Give a sorbent to cleanse the body (Enterosgel, Smecta, activated carbon).
- Lay the patient on his back, and place a pillow or roller under his head.
If the patient has lost consciousness, then he is laid on his side. This will prevent choking by vomiting. Before the doctor arrives, the patient must remain at rest, while it is very important to monitor breathing and heart function.
Therapy
Treatment of poisoning with amitriptyline is carried out in a hospital. If the patient is in a coma, then he is placed in the intensive care unit.
With mild poisoning, the patient is washed the stomach and give laxatives. This helps to remove amitriptyline from the body.
In more severe cases, to cleanse the body, they put droppers with infusion solutions or carry out hemosorption.
With amitriptyline poisoning, antidotes are not administered. To date, such an antidote does not exist. Antidepressant intoxication can only be treated symptomatically.
After improvement, the patient is prescribed the following drugs:
- Cholinesterase inhibitors (Prozerin, Physostigmine). These agents are not antidotes, but they significantly reduce the anticholinergic effect of amitriptyline. Shown with severe inhibition of the central nervous system.
- Corticosteroids. Hormonal drugs are administered with a drop in blood pressure.
- Antiarrhythmic drugs. These drugs are prescribed for poisoning, accompanied by malfunctions of the heart rhythm.
Patients are also shown inhalation with oxygen. In severe cases, patients are connected to a ventilator. In the first 5 days, round-the-clock monitoring of respiration, blood pressure and heart function is necessary.
How does poisoning affect health
Even with timely medical care, complications after intoxication cannot be ruled out. The effects of amitriptyline poisoning can affect health for a long time after recovery.
Intoxication primarily affects the central nervous system. After relief of acute symptoms, the following pathological manifestations may persist:
- unsteady gait;
- movement coordination disorders;
- deterioration in mental activity;
- muscle weakness;
- frequent relapses of depression.
With severe intoxication, complications can also arise from other organs:
- pneumonia;
- arrhythmia;
- insufficiency of the function of the heart, liver and kidneys;
- frequent bleeding.
If the poisoning was accompanied by a serious visual impairment, then it is not always possible to completely eliminate the spasm of accommodation. In many people, myopia after intoxication remains forever.
Conclusion
Drug poisoning from depression is one of the most dangerous drug intoxications. Therefore, when taking such funds, extreme caution must be exercised. After all, the consequences of an overdose can be irreversible. Exceeding the permissible number of tablets, you can cause irreparable harm to your health.