Analytical review of side effects and lethal cases of acute poisoning by antipsychotics and antidepressants




antipsychotics, antidepressants, poisoning, side effects, chemical-toxicological analysis


Topicality. Increase in the use of antipsychotics and antidepressants in many countries led to augmentation of acute poisoning amount with lethal cases. Among them, the main part is combined poisoning, including combination with other medicines, which significantly complicates the conduction of chemical-toxicological analysis.

Aim. To conduct the analytical review of side effects and lethal cases of acute poisoning by antipsychotics and antidepressants, including combination with other medicines.

Materials and methods. Analysis of websites and online literature sources such as:,,, PubMed, ResearchGate, Scopus etc.

Results and discussion. According to the results of sources analysis, in the period from 2013 to 2018, there were registered 5094 cases of side effects and 56 lethal poisonings with the use of the most commonly used antipsychotics of phenothiazine derivatives. Also 6013 cases of side effects and 675 lethal poisonings were registered with the use of tricyclic antidepressants. The main side effects and causes of fatalities have been identified. The combined use of antipsychotics and antidepressants and its simultaneous application with medicines from other pharmacological groups, increases the risk of poisoning. It greatly complicates the chemical and toxicological searches to determine the cause of poisoning.

Conclusions. The conducted research determined the factors of deterioration the toxicological situation recently which has developed with the use of antipsychotics and antidepressants and substantiated feasibility of the development of methods of chemical-toxicological analysis for drugs that caused fatal poisoning.

Author Biographies

S. Merzlikin, National University of Pharmacy

Doctor of Pharmacy, Professor of the Department of Drug and Analytical Toxicology

T. Kucher, I. Horbachevsky Ternopil National Medical University

PhD in Pharmacy, Assistant of the Department of Pharmaceutical Chemistry

V. Stepanenko, National University of Pharmacy

PhD in Pharmacy, Associate Professor of the Department of Drug and Analytical Toxicology

O. Pogosyan, National University of Pharmacy

PhD in Pharmacy, Associate Professor of the Department of Drug and Analytical Toxicology


Chekman, Y. S., Belenychev, Y. F., Gorchakova, N. A., Bukhtyarova, N. V., Nagornaia E. A. (2018). Ostrye otravleniia lekarstvennymi preparatami : diagnostika, mery neotlozhnoi terapii. Kyiv, Zaporizhia, 100.

Tiihonen, J., Mittendorfer-Rutz, E., Torniainen, M., Alexanderson, K., & Tanskanen, A. (2016). Mortality and Cumulative Exposure to Antipsychotics, Antidepressants, and Benzodiazepines in Patients With Schizophrenia: An Observational Follow-Up Study. American Journal of Psychiatry, 173 (6), 600–606.

Nedashkivskii, S. M., Galushko, O. A. (2016). Ostrye i neotlozhnye sostoianiia v praktike vracha, 5, 20–28.

Shcho vidomo pro efektyvnist ta bezpeku likarskykh zasobiv v Ukraini? (2018). Available at :

Chekman, I. S., Gorchakova, N. O., Kazak, L. I. (2011). Farmakologiya. Vinnytsia, Nova knyha, 784.

Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17 (3), 341–356.

Desmarais, J. E., Beauclair, L., Annable, L. (2014). Effects of discontinuing anticholinergic treatment on movement disorders, cognition and psychopathology in patients with schizophrenia. Ther Adv Psychopharmacol., 4, 257–267.

Newcomer, J. W., Weiden, P. J., Buchanan. R. W. (2013). Switching antipsychotic medications to reduce adverse event burden in schizophrenia: establishing evidence-based practice. J Clin Psychiatry, 74, 1108–1120.

Gardner, D. M., Abidi, S., Ursuliak, Z. (2015). Incidence of oculogyric crisis and long-term outcomes with second-generation antipsychotics in a first-episode psychosis program. J Clin Psychopharmacol., 35, 715–718.

Taylor, J., Anderson, W. S., Brandt, J. (2016). Neuropsychiatric complications of Parkinson disease treatments: importance of multidisciplinary care. Am J Geriatr Psychiatry, 24, 1171–1180.

Juncal-Ruiz, M., Ramirez-Bonilla, M., Gomez-Arnau, J., Ortiz-Garcia de la Foz. V., Suarez-Pinilla, P., Martinez-Garcia, O., Neergaard, K. D., Tabares-Seisdedos, R., Crespo-Facorro, B. (2017). Incidence and risk factors of acute akathisia in 493 individuals with first episode non-affective psychosis: a 6-week randomised study of antipsychotic treatment. Psychopharmacology, 234, 2563–2570.

Carbon, M., Hsieh, C. H., Kane, J. M. Correll, C. U. (2017). Tardive dyskinesia prevalence in the period of second-generation antipsychotic use: a meta-analysis. J Clin Psychiatry, 78, 264–278.

Pobichni efekty preparativ. (2019). Available at:

Pobichni efekty preparativ. (2019). Available at:

Pobichni efekty per fenazynu. (2019). Available at:

Vypadky peredozuvannia perfenazynom z amitryptylinom. (2019). Available at:

Merzlikin, S. I., Kucher, T. V., Stepanenko, V. I., Pogosyan, O. G. (2019). Ukrayins`ky`j biofarmacevty`chny`j zhurnal, 2 (59), 14–20.

Vypadky suitsydiv prokhlorperazynom. (2019). Available at:

Pobichni efekty proliksynu. (2019). Available at:

Pobichni efekty Melarylu. (2019). Available at:

Kovalenko, V. N. (Ed.). (2015). Kompendium 2015 – lekarstvennye preparaty. Kyiv: Morion, 2448.

Drogovoz, S. M., Lukianchuk, V. D., Sheiman, B. S. (2014). Meditcina neotlozhnykh sostoianii, 2 (57), 90–94.

Rochester, M. P., Kane, A. M., Linnebur, S. A., Fixen, D. R. (2018). Evaluating the risk of QTc prolongation associated with antidepressant use in older adults: a review of the evidence. Ther Adv Drug Saf., 9 (6), 297–308.

Batchvarov, V. N. (2014). The brugada syndrome – diagnosis, clinical implications and risk stratification. Eur Cardiol. 9 (2), 82–87.

Hawton, K., Bergen, H., Simkin, S. Cooper, J., Waters, K., Gunnell, D., Kapur, N. (2010). Toxicity of antidepressants: Rates of suicide relative to prescribing and non-fatal overdose. The British journal of psychiatry: the journal of mental science. 196 (5), 354–358.

Sheridan, D., Lin, A., Horowitz, B. Z. (2018). Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants. Clin Toxicol (Phila), 56 (5), 360–364.

Coupland, С., Hill, T., Morriss, R., Arthur, A., Moore, M., Hippisley-Cox, J. (2015). Antidepressant use and risk of suicide and attempted suicide or self harm in people aged 20 to 64: cohort study using a primary care database. BMJ, 350, 517–530.

White, N., Litovitz, T., Clancy, C. (2008). Suicidal antidepressant overdoses: a comparative analysis by antidepressant type. J Med Toxicol., 4, 238–250.

Baun, B. T., Brinon, M., Larsen, K. G. (2018). Sotcialnaia i klinicheskaia psikhiatriia, 2, 45–49.

Li, W., Lamichhane, J. (2017). From heartbreak to left bundle branch block: a case of amitriptyline overdose. American Journal of Therapeutics, 24, 621–623.

Kiberd, M. B., Minor, S. F. (2012). Lipid therapy for the treatment of a refractory amitriptyline overdose. CJEM, 14, 193.

Pobichni efekty amitryptylinu. (2019). Available at:

Vypadky suitsydu nortryptylinom. (2019). Available at:

Pobichni efekty imipraminu hidro khlorydu. (2019). Available at:

Vypadky suitsydu imipraminom. (2019). Available at:

Pobichni efekty dezypraminu. (2019). Available at:

Vypadky suitsydu dezypraminom. (2019). Available at:

Vypadky suitsydu amoksapinom. (2019). Available at:

Pobichni efekty maprotylinu. (2019). Available at:

Vypadky suitsydu mirtazapinom. (2019). Available at:

Tcipriani, A. Furukama, T. A., Salanti, Dzh. (2018). Sotcialnaia i klinicheskaia psikhiatriia, 4, 61–69.

Medvedev, V. E. (2012). Psikhiatriia i psikhofarmakoterapiia, 1, 53–56.

Vieweg, W. V., Wood, M. A., Fernandez, A., Beatty-Brooks, M., Hasnain, M., Pandurangi, A. K. (2009). Proarrhythmic risk with antipsychotic and antidepressant drugs: implications in the elderly. Drugs Aging, 26(12), 997–1012.

Pobichni efekty tryavilu. (2019). Available at:

Sobennikov, V. S. (2013). Zhurnal nevrologii i psikhiatrii im. S. S. Korsakova, 2, 20–24.

Kondratenko, S. N., Saveleva, M. I., Kukes, V. G., Shikh, E. V., Gneushev, E. T. (2019). Biulleten eksperimentalnoi biologii i meditciny, 3, 330–337.

Mao, Y. M., Zhang, M. D. (2015). Augmentation with antidepressants in schizophrenia treatment: benefit or risk. Neuropsychiatr Dis Treat, 16, 701–713.

Zink, M., Englisch, S., Meyer-Lindenberg, A. (2010). Polypharmacy in schizophrenia. Curr Opin Psychiatry, 23 (2), 103–111.

Zotov, P. B., Prilenskii, A. B. (2017). Suitcidologiia, 4(29), 98–106.





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