Only attempt emesis in asymptomatic animals. An enema is recommended if sustained-release products are consumed. Activated charcoal binds tightly to these drugs and can be used as the only decontamination procedure. 1 Diuresis does not enhance excretion because SSRIs and novel antidepressants are highly protein-bound. But consider administering fluid therapy to help support blood pressure and maintain renal function.
Treatment is otherwise symptomatic and supportive.
When dogs ingest more than one type of antidepressant medication, the likelihood of serotonin syndrome increases. The syndrome most commonly occurs when two or more serotonergic agents with different mechanisms of action are ingested either concurrently or in close succession, leading to excessive serotonin concentrations in the central nervous system. Other drugs such as 5-hydroxytryptophan, dextromethorphan hydrobromide, and lithium act synergistically with TCAs, MAOIs, SSRIs, and novel antidepressants and can lead to serotonin syndrome. Because of the severity of the signs, serotonin syndrome is much more difficult to treat than a simple overdose. Signs generally resolve over 12 to 24 hours, but you must closely monitor affected dogs.