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May 8, 1987

The Toxicity of Tricyclic Antidepressants

JAMA. 1987;257(18):2435. doi:10.1001/jama.1987.03390180053012

To the Editor.—  The article entitled "Tricyclic Antidepressant Overdose: A Review"1 provides a useful reference for the management of antidepressant overdose. However, several important issues relating to the newer antidepressants deserve mention.In addition to the significant central nervous system toxicity observed with amoxapine overdosage,1 renal failure may develop several days after acute ingestion in patients who otherwise appear to have recovered.2 In a series of 112 cases of amoxapine overdosage reported by Jennings et al,2 13 cases of acute renal failure developed. Evidence of acute tubular necrosis with rhabdomyolysis and myoglobinuria was a frequent finding in these patients and approximately 40% of these patients required dialysis.2With regard to trazodone hydrochloride, the authors note that "trazodone appears to be much less toxic than TCAs [tricyclic antidepressants] after acute overdose." Although an earlier report of 206 cases of trazodone overdosage3 found no fatalities, a