OBJECTIVE To review poisoning with tricyclic antidepressants. METHODS English language literature search using Australian Medlars Service (1977-1989), manual search of journals and review of bibliographies in identified articles. METHODS Approximately 250 articles, abstracts and book chapters were selected for analysis. METHODS The literature was reviewed and 93 articles were selected as representative of important advances. RESULTS The major features of overdose are neurological, cardiac, respiratory and anticholinergic. Life-threatening complications develop within six hours of overdose or not at all. All patients seen within six hours of overdose should have their stomachs emptied. All patients should receive activated charcoal. Coma, convulsions, respiratory depression and hypotension are treated with standard resuscitation techniques and drugs. Treat patients with significant cardiotoxicity or cardiac arrest with alkalinisation by sodium bicarbonate or hyperventilation, aiming for an arterial pH of 7.45-7.55. Lignocaine is used for ventricular arrhythmias. Other antiarrhythmic drugs are contraindicated (Class 1A, Class 1C), potentially lethal (Class II), of no benefit (phenytoin) or of unproven efficacy (Class III and Class IV). Physostigmine has no role at all. Haemodialysis and haemoperfusion are of no benefit. CONCLUSIONS The death rate of those who reach hospital is 2%-3%. Most of these deaths are cardiac in origin, and are caused by direct depression of myocardial function rather than cardiac arrhythmias.