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As a GP & BASICS doc I'd like to make the following points about TCAs/SSRIs. 1. There is considerable variation in patient response to both classes of antidepressants. Some folks feel better with TCAs than SSRIs & vice-versa. 2. A lot of patients I try on SSRIs feel b awful with worse insomnia & anxiety. 3. TCAs are very useful as non-addictive hypnotics, for chronic pain control & also for IBS. They are a very useful type of drug. 4. Many Health Authorities effectively black-listed SSRIs, until recently ,on cost grounds! 5. If I had to make a choice between keeping TCA s or SSRIs, I would keep TCAs as they are far more useful than SSRIs. 6. The problem, as everyone is pointing out, is their toxicity in overdose. I really don't have an answer. Yes we can issue weekly or fortnightly scripts, but this becomes v expensive for those who pay a script charge. Also, there is nothing to stop people hoarding tabs until they have enough to do the job properly! Unfortunately, anxiety & depression remains one of the commonest problems GPs face and we have to respond as best we can. Perhaps TCAs could be dispensed in weekly amounts by the pharmacy, at no extra charge to the patient. 7. Finally, the root cause of many folks 'depression' is socio-economic. Medicine is somehow expected to produce a magic cure!! Best wishes Dr John Apps 'I've spent a lot of money on booze, birds & fast cars. The rest, I've squandered !' George Best -----Original Message----- From: Tom Moore [SMTP:[log in to unmask]] Sent: 17 March 1999 07:16 To: [log in to unmask] Cc: [log in to unmask] Subject: Re: Tuesday soapbox: tricyclics and death Rowley, I think that you're right in some respects . The GP reaches for the the TCA's because they are cheap, but they are also very effective. I think there would be a large number of chronically sick patients with acopia without a small dose of TCA's. We use them because they are effective in the pharmacopoeia, and life would be more difficult without them. But, as you say, the GP's don't see the 0D's, and still prescribe huge quantities as repeat prescriptions. Maybe there is a compromise with limited numbers prescribable, and never on repeat prescription - but very hard to police. Tom Moore -----Original Message----- From: Rowland Cottingham <[log in to unmask]> To: [log in to unmask] <[log in to unmask]> Cc: [log in to unmask] <[log in to unmask]> Date: 16 March 1999 21:12 Subject: Re: Tuesday soapbox: tricyclics and death >In-Reply-To: <[log in to unmask] >k> >This sounds like an eminent task for NICE to me. I agree; the GP reaches >for the tricyclic because it is cheap. He doesn't see the overdose. > >Best wishes, > > >Rowley Cottingham > >[log in to unmask] > >"Something that travels from where I'm not, to where I don't want to be, >at a time I don't want to travel". Definition of public transport. > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%