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Article   |    
Psychiatric Side Effects of Tricyclic Antidepressants
James H. Meador-Woodruff
Psychiatric Services 1990; doi:
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Department of Psychiatry and Mental Health Research Institute, University of Michigan Medical Center, 205 Washtenaw Place, Ann Arbor, Michigan 48109

1990 by the American Psychiatric Association

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Abstract

Psychiatric toxicity to tnicycic antidepressants may be an underrecognized adverse effect of treatment with tricyclics, possibly occurring in between 5 and 15 percent of patients. Such toxicity is probably mediated by a central antimuscarinic action of the tricyclics and is associated with elevated plasma tricyclic levels, age, polypharmacy, and perhaps underlying cholinergic defects in susceptible individuals. Once tricyclic-induced toxicity is recognized, the treatment consists of discontinuing the tricyclic and providing supportive care as necessary. Many cases of tricyclic-induced toxicity may be preventable through close attention to the mental status examination and judicious monitoring of plasma tricyclic levels during treatment.

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