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Many benefits from careful prescribing of tricyclics

Thank you for raising the important and interesting topic of antidepressant prescribing in general practice.

As a full-time GP I was interested in the comments of Dr Nick Dunn (News, October 13) who obviously has a position of influence. As such I would have expected him to have given a more balanced view on the use of medications. Surely as GPs we are not simply gatekeepers between patients and the contents of the BNF. Many patients are more knowledgeable than us about a whole variety of medications, and access to information is virtually limitless.

No ­ our role, in prescribing, is less that of the 'expert' paternally dispensing largesse and more that of the 'risk manager'. This is because all medication carries significant and frequently quantifiable risk. That risk is set against predicted or anticipated benefit.

In this particular discussion on antidepressants there are many benefits from the judicious use of tricyclics.

In short, there are many medications we all prescribe that are significantly dangerous in either overdose or combination, but this art/science of prescribing is at the very heart of our daily clinical activity. Of course it needs to be evaluated through intelligent and balanced review ­ both objectively and in liaison with the patient or their family.

I do not find Dr Dunn's sweeping statements about a large and important group of medications as helpful as they could have been.

Dr Stephen Bird


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