Tricyclic antidepressants suicidality from

Apart from symptomatic, general measures (gastric lavage, cooling with ice water), therapy of severe atropine intoxication includes the administration of the indirect parasympathomimetic physostigmine (p. 102). The most common instances of atropine" intoxication are observed after ingestion of the berry-like fruits of belladonna (children) or intentional overdosage with tricyclic antidepressants in attempted suicide. 

Damluji and Ferguson (1988) reviewed paradoxical worsening of depressive symptomatology caused by antidepressants in an article of the same title and reported four cases of their own caused by the older antidepressants amoxapine, desipramine, nortriptyline, and trazodone. The APA National Task Force on Women and Depression (1990) report on benzodiazepines also cited the problem of depression and suicide from tricyclic antidepressants. 

In materials gained through discovery in the Wesbecker case, I found in-house documents from Eli Lilly clearly demonstrating an increased rate of suicide attempts in Prozac patients compared to placebo and to tricyclic antidepressants (Breggin, 1994 available on http //www.breggin. com). This was a shocking discovery as Eli Lilly claimed, and continues to claim, that no such data exist. 

Educational policies and commercial marketing of antidepressant drugs have led to an increase in the detection and treatment of depression. Conceivably this may be associated with the fall in suicide rates noted in Finland. However, overdosage of tricyclic antidepressants continues to contribute to deaths from suicide. Whether completely replacing tricyclics with less toxic compounds would lower overall suicide rate remains controversial. 

Paracetamol plus dextropropoxyphene, the combination known as co-proxamol, is available as a prescription-only analgesic in many countries. Self-poisoning can be lethal, as respiratory depression can occur from an excessive dose of dextropropoxyphene. In England and Wales, co-proxamol alone accounts for 5% of all suicides, and overdose is more likely to result in death than overdose with paracetamol alone or tricyclic antidepressants (81). Furthermore, although it is often prescribed, it is no more effective than paracetamol for short-term relief of pain. It should not be prescribed without good... 

Limited effectiveness and toxicity are the major reasons for switching a patient from one antidepressant drug to another. SSRIs are sometimes superior to tiicychcs in their clinical efficacy, and in this case amitriptyline had not proved effective after a reasonable trial (8 weeks). At that time, the depressive symptoms in this patient included feelings of worthlessness and possibly suicidal ideation. Tricyclic overdose is especially dangerous in depressed patients, who often use medications close at hand in attempting suicide. Ingestion of just a 2-week supply of amitriptyline can cause severe hypotension, cardiac arrhythmias, seizures, coma, and death ( one-prescription lethal ). 

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