<prompt> A female treatment for depression took a massive dose of amitriptyline for suicide. Which of the following is wrong regarding management for her?Gastric lavage was doneSedium bicarbonate was administered to treat acidosisAtropine sulphate was administered as an antidoteDiazepam was injected to control seizures.  <response>: Ans. c. Atropine sulphate was administered as an antidote Ref: Reddy 28e p524: Goodman Gilman 11448Tricyclic antidepressants amitriptyline cause anticholinergic effects such as dry skin, ileus, urinary retention etc., administration of atropine would further worsen these symptoms. Atropine is better avoided in poisoning or overdose of cyclic antidepressants.PoisoningOverdose of Cyclic AntidepressantsMechanism of Action:Inhibition of neurotransmitter uptake leading to cholinergic and alpha-adrenergic blockadeDirect myocardial depressant effectSystemic SymptomsCNS SymptomsCVS SymptomsParasympathetic Depression of mental state Coma, Delirium Altered sensorium Generalized brief and self-limited convulsions Myoclonus, NystagmusQ Dysarthria, AtaxiaQ Sinus tachycardiaQ Conduction delays Ventricular arrhythmias Negative inotropic action HypotensionQ Dry skin and mucosaQ IleusQ Urinary retentionQ MydriasisQ HypothermiaQPoisoningOverdose of Cyclic AntidepressantsTreatment:Gastric lavage to remove the unabsorbed drugEmesis should be avoided; Activated charcoal can be usedSymptomatic treatment:Sodium bicarbonate to treat acidosisQAnti-convulsants to treat seizures 