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Antidepressant suicide is not about drug type

Yourarticle about the toxicity of tricyclics misses the point, as do Professor Mageed's statistics (News, October 13). Surely it is obvious that a drug that is relatively non toxic in overdose will be less likely to cause death than one that is toxic. You hardly needed to do the research to show this.

The important issue is whether depressed patients prescribed tricyclics are more likely to die by suicide (using whatever drug or other method) than those prescribed SSRIs. The perhaps startling fact is that they are not.The reason must be that SSRI patients choose other ways to kill themselves.

It may even be that they are more likely to want to kill themselves because SSRIs are less-effective antidepressants, particularly for those with serious depression with biological features.

Ibelieve ­ but there is as yet no evidence ­ that patients with short-termenvironmentally mediated depression are less tolerant of tricyclics and stop taking them, while those with more serious biological depression continue to take them.

Tricyclics are actually more effective than SSRIs but in an unselected mixed depressed population the less depressed get better with the SSRIs ­and would do so even if they stopped them ­ matching in numbers the seriously depressed who get better with tricyclics, and who wouldn't get better without them. The supposed equal efficacy of tricyclics and SSRIs is a myth produced by these compensating statistical quirks.

The seriously depressed on SSRIs who don't get better on them are therefore more likely to commit suicide, though they obviously don't use their relatively harmless (and relatively useless) tablets to do it.

Dr Arnold Zermansky

GP and Visiting Senior Research Fellow at Leeds University

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