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LETTERS: Hugh M Jones, Imad M Ali, Janet E Martin, Toshi A Furukawa, Corrado Barbui, and Hugh McGuire Low dosage tricyclic antidepressants in depression BMJ 2003; 326: 499a [Full text]

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Suicide dose tricyclics

Katrina J Gardiner   (1 March 2003)

Suicide dose tricyclics 1 March 2003
Katrina J Gardiner, VTS SHO Stoke Mandeville hospital,Aylesbury, HP21 8AL Send response to journal: Re: Suicide dose tricyclics	Dear Sir True, the question remains as to whether low dose tricyclics can adequately treat an episode of clinical depression. However, a clinically important point is that tricyclics are potentially dangerous drugs and their prescription should be carefully monitored. I have come across a number of patients during my appointment as a psychiatry SHO, whereby depressed patients are referred from General Practice to the hospital on doses of 25-50mg OD dothiepin. Surely this practice is downright dangerous, I call it the 'suicide dose' - the patient's affective disorder is inadequately treated, the patient remains depressed and the doctor is handing out prescriptions for drugs that can be lethal in overdose. Could this be assisted suicide?! Perhaps this method of low dose prescribing should be the domain of the consultant psychiatrist and as GPs we should wait for a more solid evidence-base? Competing interests:   None declared