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Plasma catecholamine levels in cyclic antidepressant overdose.

K S Merigian1, J R Hedges, L A Kaplan

  • 1Department of Emergency Medicine, University of Cincinnati Medical Center, Ohio.

Journal of Toxicology. Clinical Toxicology
|January 1, 1991
PubMed
Summary

Cyclic antidepressant overdose causes significant mortality, primarily due to cardiotoxicity. This study found QRS duration correlated with plasma norepinephrine, suggesting a link between cardiotoxicity and adrenergic state in overdose patients.

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Area of Science:

  • Toxicology
  • Cardiology
  • Pharmacology

Background:

  • Cyclic antidepressant (TCA) overdose is a leading cause of death in self-poisoned individuals.
  • Cardiotoxicity is the primary driver of mortality in TCA overdose.
  • The relationship between elevated catecholamine levels and cardiotoxicity in TCA overdose is not fully understood.

Purpose of the Study:

  • To investigate the correlation between QRS duration, a marker of cardiotoxicity, and plasma catecholamine levels in patients with acute TCA overdose.
  • To explore potential interactions between a hyper-adrenergic state and cardiotoxicity in TCA overdose.

Main Methods:

  • Plasma catecholamine levels (norepinephrine and epinephrine) were measured in 41 symptomatic patients with acute TCA overdose.
  • Linear multivariable regression analysis was employed to assess the relationship between QRS duration and various clinical and biochemical parameters.

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  • Pulse rate was also monitored as a physiological indicator.

    • Main Results:

    • QRS duration showed a significant correlation with the presence of cyclic antidepressants, plasma norepinephrine levels, the norepinephrine to epinephrine ratio, and pulse rate (p < 0.001, R² = 0.42).
    • Despite elevated catecholamine levels, commensurate systemic physiological changes were not observed in the TCA overdose group.
    • This suggests a potential blunted systemic response to catecholamines in TCA overdose.

    Conclusions:

    • Elevated plasma norepinephrine and a higher norepinephrine to epinephrine ratio are associated with prolonged QRS duration in cyclic antidepressant overdose.
    • Adrenergic desensitization may explain the lack of expected physiological responses to high catecholamine levels in TCA overdose.
    • Further investigation into serial catecholamine levels could refine current understanding of TCA-induced cardiotoxicity and guide therapeutic strategies.