Relative Toxicity of Selective Serotonin Reuptake Inhibitors (SSRIs) in Overdose

  title={Relative Toxicity of Selective Serotonin Reuptake Inhibitors (SSRIs) in Overdose},
  author={Geoffrey K. Isbister and Steven J. Bowe and Andrew H Dawson and Ian M. Whyte},
  journal={Journal of Toxicology: Clinical Toxicology},
  pages={277 - 285}
Background: Selective serotonin reuptake inhibitors (SSRIs) have increasingly replaced tricyclic antidepressants (TCAs) in the treatment of depression. They appear to be safer in overdose, but there is little information on their spectrum of toxicity in overdose, or relative toxicity of each agent. Objective: To determine the effect of SSRIs in overdose, as a group, and the relative toxicity of five different SSRIs. Methods: A review of consecutive SSRI poisoning admissions to a single… 

Tolerability of Selective Serotonin Reuptake Inhibitors

It is recommended in the elderly that SSRIs should be titrated slowly to recommended therapeutic doses and used cautiously with other agents known to have the potential for drug interactions, although the overall evidence is weak.

Selective serotonin reuptake inhibitor exposure.

The goals of treatment in this intoxication are to support the animal, prevent further absorption of the drug, support the central nervous system, control hyperthermia, and halt any seizure activity.

Tolerability and safety of fluvoxamine and other antidepressants

Although the literature suggests that there are no clinically significant differences in efficacy amongst SSRIs, treatment decisions need to be based on considerations such as patient acceptability, response history and toxicity.

Comparison of citalopram and other selective serotonin reuptake inhibitor ingestions in children

Doses associated with significant outcomes suggest that the triage guideline for citalopram does not need to be modified, and children develop minimal toxicity with SSRI ingestions.

QTc Intervals in Drug Poisoning Patients with Tricyclic Antidepressants and Selective Serotonin Reuptake Inhibitors

It was determined that SSRI group drugs caused similar expansion of the QTc period as TCA drugs but they did not reach high values like TCA Drugs, and their OTc intervals stayed in more innocent levels.

Selective serotonin reuptake inhibitor (SSRI) toxicosis in cats: 33 cases (2004-2010).

The prognosis for SSRIs ingestion in this population of cats was excellent and decontamination and supportive care for at least 12-24 hours can be considered in cats with SSRI ingestion, particularly venlafaxine to monitor resolution of clinical signs.

Treatment of depression with selective serotonin inhibitors: the role of fluvoxamine

Fuvoxamine has a proven efficacy and safety profile in treating elderly patients with depression and its σ1-receptor binding profile may account for the observed high level of efficacy in psychotic depression and may explain the benefit of fluvoxamine in treating depression comorbid with anxiety/stress.

SNRIs: The Pharmacology, Clinical Efficacy, and Tolerability in Comparison with Other Classes of Antidepressants

Abstract The class of serotonin and norepinephrine reuptake inhibitors (SNRIs) now comprises three medications: venlafaxine, milnacipran, and duloxetine. These drugs block the reuptake of both

Serotonin Syndrome in Children and Adolescents Exposed to Selective Serotonin Reuptake Inhibitors - A Review of Literature.

  • Siqi XuevA. Ickowicz
  • Medicine, Psychology
    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent
  • 2021
Serotonin syndrome is a severe adverse drug reaction associated with SSRI, and can be associated with diverse presentations in the pediatrics population and diagnostic challenges, and Clinicians are recommended to be vigilant in the monitoring and recognition of serotonin syndrome.


Clinicians must maintain a high clinical suspicion for the SS because of the widespread use of antidepressants, and the avoidance of multidrug regimens is critical to the prevention of the SS.



Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants.

Venlafaxine and dothiepin are pro-convulsant in overdose, but less likely to cause coma than TCAs and SSRIs, and Antidepressants other thanTCAs or venlafxine should be considered in patients at risk of seizure or suicide.

Selective serotonin reuptake inhibitor-induced serotonin syndrome: review.

To reduce the occurrence, morbidity, and mortality of the serotonin syndrome, it must be both prevented by prudent pharmacotherapy and given prompt recognition when it is present.

SSRI safety in overdose.

The SSRI antidepressants are far safer than the TCAs in overdose, and there is no apparent difference among SSRIs with respect to overdose safety.

Fatal toxicity associated with antidepressant use in primary care.

  • J. MasonN. FreemantleM. Eccles
  • Medicine, Psychology
    The British journal of general practice : the journal of the Royal College of General Practitioners
  • 2000
Fatalities from antidepressant poisoning are very rare but if safety is paramount then lofepramine or an SSRI are justifiable treatment choices.

Antidepressant overdoses and resultant emergency department services: the impact of SSRIs.

This study evaluates demographic variables of antidepressant overdoses to determine whether differences exist in treatments and monitoring, and evaluates costs associated with care and the impact of co-ingestants on those same factors.

Cardiac safety of citalopram: prospective trials and retrospective analyses.

Results showed that citalopram has no effect on cardiac conduction and repolarization during short- or long-term treatment, and there were no significant effects on PQ, QRS, or QTc intervals.

Risks and Benefits of Selective Serotonin Reuptake Inhibitors in the Treatment of Depression

Current data support a decreased frequency of suicidal ideation with all antidepressants, including selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), which provides fluoxetine with an overall superior therapeutic profile.

Symptoms and signs of severe citalopram overdose

Paroxetine (Paxil) overdose: a pediatric focus.

In contrast to more toxic antidepressants in the pediatric group, paroxetine overdose patients are less likely to develop toxic manifestations, andgestions of 120 mg or less in children < or = 5 y led to favorable outcomes following gastrointestinal decontamination and minimal supportive care.

Greater toxicity in overdose of dothiepin than of other tricyclic antidepressants