Tricyclic Antidepressant Poisoning: A 6-year Retrospective Observational Cross-sectional Analysis of Emergency Department Presentation, Clinical Severity, and Hospital Outcomes in a Tertiary Academic Center.

BACKGROUND AND AIMS: Tricyclic antidepressant (TCA) poisoning remains a significant cause of toxicological morbidities due to its cardiotoxic and neurotoxic effects. We aimed to study the clinical profile, management, and outcomes of patients presenting with TCA overdose to an Indian emergency department (ED). PATIENTS AND METHODS: This retrospective study analyzed patients with TCA poisoning over a 6-year period. A multivariate logistic regression model was constructed to identify factors independently associated with poor outcomes. RESULTS: Our study analyzed 75 patients with TCA overdose (mean age: 35.1 ± 13.01 years, 84.0% female). Amitriptyline was the most common drug (69.3%), followed by imipramine (17.3%). Interpersonal issues were the most common trigger (40 cases). Clinical presentations included altered mental status (46.7%) and drowsiness (29.3%). Emergency department management included intubation (20.0%), gastric lavage/charcoal (29.3%), and sodium bicarbonate (70.7%). Patients with poor outcomes had a higher median amitriptyline dose than those with good outcomes [474.47 mg (interquartile range [IQR]: 590) vs 266.43 mg (IQR: 375), p = 0.028]. Patients who required intubation had poor outcomes (p < 0.001). Kaplan-Meier analysis of time to in-hospital death showed significantly lower survival in the amitriptyline overdose group than in the other TCA overdose group (log-rank p = 0.017). There were 12 deaths overall. CONCLUSIONS: Tricyclic antidepressant overdose, predominantly involving amitriptyline, was commonly triggered by interpersonal issues and frequently presented with altered mental status. Poor outcomes were associated with a higher amitriptyline dose and need for intubation.