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Table 16.3 Risk stratification for antidepressant overdose-induced seizures [ 32 ]
Risk for antidepressant overdose-induced seizures
Antidepressant class
representative drugs
from each class
Low risk 10 %
seizure incidence
after overdose
MAOIs
b
Isocarboxazid + – –
Moclobemide + – –
b
Phenelzine + – –
b
Selegiline + – –
b
Tranylcypromine + – –
CAs
Tertiary amines
Amitrtiptyline – + –
Clomipramine – + –
Doxepin – + –
Imipramine – +
Trimipramine – + –
Secondary amines
Desipramine – – +
Nortriptyline – – +
Protriptyline – + –
Other
Amoxapine – – +
Maprotiline – – +
SSRIs
c
Citalopram – + –
Escitalopram + – –
Fluoxetine + – –
Fluvoxamine + – –
Paroxetine + – –
Sertraline + – –
Atypical antidepressants
Bupropion – – +
Duloxetine Risk unknown – –
Mirtazapine + – –
Reboxetine Risk unknown – –
Trazodone + – –
d
Venlafaxine – + –
Reprinted from Psychiatric Clinics of North America, Judge and Rentmeester [ 32 ], © 2013, with
permission from Elsevier
a
Data compiled from multiple sources referenced throughout the article. The table was constructed
solely by the authors
b
Seizure risk with overdose presumed to be low based on lack of convincing clinical evidence and/
or the drug shares a similar structure and/or pharmacologic mechanism to drugs within its class
that have been determined to be low risk
c
Seizure risk with overdose should be considered high with ingestions exceeding 600 mg
d
Seizure risk may be high with large ingestions