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Stop pontificating on tricyclics risk

I guess if you publish the headlines without taking overall risk into account, tricyclics look very dangerous (News, October 13).

A few years ago, acting as lead for the practice in mental health, I calculated that an individual GP in our seven-doctor practice would deal with a suicide every nine years. If we say a rate of 4,500 consultations a year, that's roughly once every 40,000 consultations.

From what I could work out on the local risk, a GP here would see a tricyclic-induced suicide once every three GP lifetimes ­ in the order of once every half million consultations.

Tricyclics are used increasingly in the management of pain, indeed our local pain clinic won't take a referral unless there has been a satisfactory trial of amitriptyline first.

There is certainly a case for not giving tricyclics to people with suicidal ideation, particularly if it includes suicide planning, but there is also some suggestion that some SSRIs may increase suicidal risk or aggressive behaviour that may be equally dangerous either to the patient or to society.

Can we get rid of the ivory tower pontification and see these events as they occur in the real world, in the context of the individual and their risks to themselves and society, instead of jumping for 'one size fits all' reactive solutions. Isn't that what professionalism is about?

Dr Bern Bedford

Hythe, Hampshire

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