Whilst most Gp's and A&E Doc's are more than aware of the efficacy of SSRIs
in treating depression and the toxicity of TCA's in overdose;TCA's remain an
exceptionally useful therapeutic group of drugs.
The secret is tailoring the right right drug to the right patient, this
entails a comprehensive mental state examination and identification of self
harm risk factors or suicidal ideation should be a strong persuader to use
either SSRI,s or controlled prescription of TCA's.
Anecdotally most of the fatal TCA overdoses i,ve come across involve
prothiaden (dothiepin) . Is there any evidence to suggest it behaves
toxicologically different in overdose or could it subtly affect
suicidal/self harm behaviour ?
Dr Mark Nettleton MBBS MRCGP DGM Dip IMC RCS Ed
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