Tricyclics More Cause Than Cure for Suicidality

Tricyclics More Cause Than Cure for Suicidality  

There is no substantial published evidence that any antidepressants, new or old, ameliorate suicidal tendencies. Instead, there is clinical evidence that the tricyclic antidepressants, like the SSRIs, can cause suicide. Baldes-sarini (1978) warned, The risk of suicide may even increase with initial improvement, since activity usually increases before mood elevation. Baldessarini s explanation for drug-induced suicidality, formulated many years ago, is oversimplified but the observation remains correct, that antidepressants cause suicidality, especially early in treatment or during dose changes. 

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. 

Tragically, while the older antidepressant drugs cannot prevent suicide and can cause it, in relatively small amounts, they can become lethal instruments in the hands of suicidal patients. As little as 1 week s supply of most tricyclics can cause death, often due to cardiac dysfunction. In combination with other drugs, their lethality increases. Thus millions of depressed, suicidal patients are given the tool with which to kill themselves. By 1981, the tricyclics were overtaking the barbiturates as the medications most frequently involved in serious overdoses ( Tricyclics, 1981). The tricyclics remain a major public health problem as agents of suicide (Henry et al., 1995). 

---