Abstract
In their review of the clinical use of the tricyclic antidepressants (TCAs), Boyce and Judd rightly point out that the lethality of the TCAs in overdose is only one of many variables to be considered by the clinician aiming to effectively treat, inter alia, patients' suicide risk [1]. Contrary to industry propaganda, use of newer drugs fails to lessen relative suicide risk, as shown by Jick et al. [2] who compared UK populations treated with 10 different antidepressants. This argument and others [3–6] effectively challenge earlier suggestions that prescribers should, for medicolegal reasons, avoid using TCAs [7].
The unfortunate fact remains that depressed patients often kill themselves, and effective treatment of depression remains our most trenchant response to suicide risk. Recent reviews of research findings [1,8] indicate that TCAs are more effective than newer antidepressants in melancholic depression, and are rated as such by patients [8].