Depression is extremely common these days. Therefore, many people have to regularly take special medications - antidepressants. But when using such drugs, you need to be very careful. This group of medicines includes drugs based on amitriptyline. 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 the active ingredient in older generation tricyclic antidepressants. 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". Trade names "Saroten" and "Triptizol" are less common.
Amitriptyline blocks the capture by nerve cells of the "hormones of joy" - serotonin and norepinephrine. As a result, these substances accumulate in the body. A person's anxiety and longing disappear, 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 an instant effect in the first days of treatment, arbitrarily increase the dose of the drug. This can lead to poisoning with amitriptyline.
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 strictly a prescription drug. It should never be taken on its own. The entire course of treatment should be under the supervision of a physician.
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 cases when patients independently increase the daily number of tablets.
- Drinking alcohol during treatment. Doctors strictly forbid drinking alcohol while taking antidepressants. Ethanol enhances the effect of psychotropic drugs. This combination dramatically depresses the nervous system.
- Taking other medications that are poorly compatible with antidepressants. Tosuch drugs include hypnotics, neuroleptics, and anticonvulsants. This combination of drugs can also lead to poisoning.
In psychiatric practice, there have been cases of drug poisoning with the aim of suicide. After all, this medicine is often prescribed for depression, and such a mental state can be accompanied by suicidal ideas. Therefore, suicidal patients 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 may mistake them for sweet vitamins and accidentally drink them. Therefore, such a powerful medicine should be hidden from children as far as possible.
Dangerous dosage
This antidepressant comes in the form of 25mg tablets. Only a doctor can choose the required dose of medicine. The entire course of treatment takes place under the supervision of a specialist. When the condition improves, the number of tablets is reduced, and when it worsens, they are increased.
The recommended dose should never be exceeded. Even when taking 6 tablets, adults show signs of mild intoxication. The dangerous dose for children is even less. A child can get poisoned by accidentally drinking 3-4 pills.
If the patient took at the same time 1.5 grams of medication (60 tablets), then this leads to death. Even if the patient has consumed a lethal dose in several doses per day, it still poses a huge danger to life.
How it developsintoxication
Consider the pathogenesis of amitriptyline poisoning. After taking a large number of tablets, the active ingredient is rapidly absorbed into the blood. The body accumulates a huge concentration of serotonin and norepinephrine. This leads to a strong overexcitation of the nervous system, the appearance of hallucinations and convulsions. Subsequently, this state is replaced by a sharp depression of brain functions and loss of consciousness up to coma.
This antidepressant also has an anticholinergic effect. Therefore, the patient's pupils dilate sharply, shortness of breath appears, unpleasant dryness in the mouth appears. With a significant excess of the permissible dose, the drug depresses respiration and cardiac activity. This is often fatal.
Amitriptyline poisoning code according to ICD-10 - T.34. This code encodes intoxications with psychotropic drugs not classified elsewhere.
In medicine, there are three degrees of intoxication. We will consider the signs of poisoning depending on the severity of the patient's condition.
Mild degree
Mild intoxication occurs with a small overdose. For example, the patient took two tablets instead of one or consumed the entire daily dose once. In this case, the following symptoms of amitriptyline poisoning appear:
- Excitement. There is motor and mental anxiety. The patient becomes restless, irritable and aggressive.
- Disorders of the excretory function. Frequent urination occurs, sometimesinvoluntary.
- Impaired vision. Due to dilated pupils, the patient does not see well. All surrounding objects seem fuzzy and blurry to him.
This mild variant of intoxication usually has a good prognosis. After a few days, the patient recovers. There are no complications in most cases.
Poisoning of moderate severity
Poisoning of moderate severity 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.
- Slowness. The patient appears lethargic, his movements are slow and poorly coordinated. Speech becomes slurred.
- Hyperthermia. The patient develops a fever (up to 38 degrees).
- Disorders of cardiovascular activity and respiration. There is a strong tachycardia, and blood pressure drops. The patient is breathing heavily and rapidly.
- Dyspeptic symptoms. The patient is worried about nausea and vomiting.
In moderate poisoning, the prognosis worsens. If the patient is not treated in time, he may lose consciousness and fall into a coma.
Severe
Severe intoxication occurs whenexceeding the therapeutic dose of the antidepressant by many times. The clinic of amitriptyline poisoning with a deadly overdose is as follows:
- loss of consciousness;
- coma;
- lack of pupillary response to light stimuli;
- dramatic drop in blood pressure;
- frequent weak pulse;
- convulsions.
This is an extremely serious condition. Without treatment, it is inevitably fatal.
How to help the sick
It is impossible to cure antidepressant poisoning at home. Therefore, an ambulance must be called immediately. The sooner doctors start treating the patient, the greater the chance of saving the patient.
If the victim is conscious, then at the pre-medical stage he needs to be given the following assistance:
- Rinse the stomach with a weak solution of potassium permanganate.
- Give a sorbent to cleanse the body ("Enterosgel", "Smektu", activated carbon).
- Lay the patient on his back, and place a pillow or cushion under his head.
If the patient has lost consciousness, then he is laid on his side. This will prevent choking on the vomit. Until the doctor arrives, the patient should remain at rest, while it is very important to monitor breathing and heart function.
Therapy
Treatment of amitriptyline poisoning is carried out in a hospital. If the patient is in a coma, then he is placed in the intensive care unit.
In case of mild poisoning, the patient is washed out of the stomach and given laxatives. This helps to remove residual amitriptyline from the body.
In more severe cases, droppers with infusion solutions are placed to cleanse the body or hemosorption is carried out.
In case of poisoning with amitriptyline, antidotes are not administered. To date, no such antidote exists. Antidepressant intoxication can only be treated symptomatically.
After the patient's condition improves, the following drugs are prescribed:
- Cholinesterase inhibitors ("Prozerin", "Physostigmine"). These drugs are not antidotes, but they significantly reduce the anticholinergic effect of amitriptyline. Shown in severe depression of the central nervous system.
- Corticosteroids. Hormonal drugs are administered when blood pressure drops.
- Antiarrhythmic drugs. These drugs are prescribed for poisoning, accompanied by heart rhythm failures.
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 poisoning affects he alth
Even with timely medical care, complications after intoxication cannot be ruled out. The consequences of amitriptyline poisoning can affect he alth long after recovery.
Intoxication primarily affects the central nervous system. After relief of acute symptoms may persistthe following pathological manifestations:
- unsteady gait;
- disorders of coordination of movements;
- deterioration of mental activity;
- muscle weakness;
- frequent relapses of depression.
In severe intoxication, complications from other organs may also occur:
- pneumonia;
- arrhythmia;
- failure of heart, liver and kidney function;
- frequent bleeding.
If the poisoning was accompanied by a serious deterioration in vision, then it is not always possible to completely eliminate the spasm of accommodation. For many people, myopia after intoxication remains forever.
Conclusion
Poisoning with drugs for 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 allowed number of tablets, you can cause irreparable harm to your he alth.
