TY - CHAP M1 - Book, Section TI - Psychotherapeutic Drugs A1 - Swoboda, Henry D. A1 - Meehan, Timothy J. A2 - Tenenbein, Milton A2 - Macias, Charles G. A2 - Sharieff, Ghazala Q. A2 - Yamamoto, Loren G. A2 - Schafermeyer, Robert Y1 - 2019 N1 - T2 - Strange and Schafermeyer's Pediatric Emergency Medicine, 5e AB - The key targets of antidepressant and neuroleptic poisoning are the cardiovascular and central nervous systems (CNS).Tricyclic antidepressant (TCA) poisoning is potentially life-threatening due to ventricular dysrhythmias and hypotension. Treatment is supportive with consideration given to sodium bicarbonate for dysrhythmia prevention and treatment, and to vasopressors for hypotension.Children who are asymptomatic for 6 hours after the ingestion of most antidepressants or neuroleptics may be discharged from the emergency department (ED).Extended observation for up to 24 hours is recommended for ingestions of monoamine oxidase inhibitors (MAOIs), bupropion, citalopram, escitalopram, and extended-release preparations of medications such as venlafaxine or desvenlafaxine.The serotonin syndrome (SS) is a life-threatening condition manifested by mental status changes, autonomic instability, hyperthermia, and neuromuscular abnormalities such as hyperreflexia and tremors. Its treatment is primarily supportive with liberal use of benzodiazepines. In severe or refractory cases, particular attention should be paid to active cooling, and consideration given to cyproheptadine.The neuroleptic malignant syndrome (NMS) is a life-threatening condition manifested by hyperthermia, skeletal muscle rigidity, and altered mental status. Its treatment is primarily supportive with first-line use of benzodiazepines, active cooling as needed, and consideration of bromocriptine.Overdose of typical neuroleptics may produce an acute dystonic reaction, which can be reversed with diphenhydramine or benztropine mesylate. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1155748907 ER -