[Tricyclic antidepressants (TAD) as a cause of unexpected death (author's transl)]

This study points to the controversy over the anti-depressant efficacy of tricyclic antidepressant drugs (TAD) and emphasize their cardiotoxicity. The number of lethal poisoning cases--from the Swiss federal statistics on the cause of death--amounted to 54 for the period from 1967 to 1976. Ten of these 54 cases occurred in children who had ingested the drug accidentally; the remaining cases concerned adults who took an overdose of the drug intentionally. In addition, the authors reviewed the forensic medical examinations performed on 11 cases of unexpected death due to lethal poisoning with TAD. Our data indicated that fatality can follow drug intake quite rapidly. Autoptical and histological findings were not specific. To confirm a poisoning diagnosis, levels of TAD and their metabolites were therefore determined in nine cases in various organ tissues and body fluids. Poisoning was due to imipramine (3 cases), opipramol (2 cases), dibenzepine (3 cases), and amitriptyline (3 cases).