BMJ 1994;309:1082 (22 October)

Letters

Selective serotonin reuptake inhibitors Drugs related to tricyclic antidepressants are a mixed bag

EDITOR, - N Freemantle and colleagues propose that, compared with selective serotonin reuptake inhibitors, "newer tricyclic and related antidepresants ... will have similar impact on rates of suicide but at considerably less cost."1 The drugs that are listed as newer tricyclic and related antidepressants, however, have important differences in pharmacology, clinical profile, toxicity, and cost.

Maprotiline is indeed related to tricyclic antidepressants both structurally and pharmacologically. It is also equally toxic,2 as table 1 of the authors' article clearly shows. To class it among compounds that are of "similar toxicity" to selective serotonin reuptake inhibitors is misleading and a serious error. Trazodone and mianserin are relatively safe in overdose but differ from selective serotonin reuptake inhibitors in being highly sedating.2 For some patients a sedating drug will be preferred,3 but this will be a clinical decision rather than an economic one. Economic factors may, of course, favour the use of . . . [Full text of this article]


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Relevant Article

Prescribing selective serotonin reuptake inhibitors as strategy for prevention of suicide
N Freemantle, A House, F Song, J M Mason, and T A Sheldon
BMJ 1994 309: 249-253. [Abstract] [Full Text]

This article has been cited by other articles:

  • Freemantle, N., Henry, D., Maynard, A., Torrance, G. (1995). Promoting cost effective prescribing. BMJ 310: 955-956 [Full text]  
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