What issues should I consider when prescribing a tricyclic antidepressant?
• Tricyclic antidepressants (TCAs) have serious adverse cardiovascular effects when taken in overdose. • One study looking at national data for England and Wales from 1993 to 1995 found that SSRIs and TCAs were both associated with low levels of fatal poisoning, but that SSRIs were associated with lower levels than TCAs [Mason et al, 2000]. • SSRIs were associated with one fatality in 411,800 treatment episodes (assuming an average treatment episode of 3 months). • The equivalent figure for TCAs was one fatality in 8130 treatment episodes. Fatality associated with the use of lofepramine was not significantly different from that associated with SSRIs. Trazodone also seemed to be associated with a low risk of fatality when taken in overdose. • These figures should be interpreted with caution, as drugs may be used selectively in people with different severities of depression and other confounding factors are likely to be present. • Because of the increased risk of cardiotoxicity, before a
