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Suicidal ideation risk rises 10-fold with nortriptyline

The tricyclic antidepressant nortriptyline is associated with almost a ten times greater risk of worsening suicidal ideation than the SSRI escitalopram in men, according to a UK study of 811 adults with moderate to severe unipolar depression.

There was no significant difference in suicidal ideation between the two treatments in women.

The study found there was 2.4 times more treatment emergent suicidal ideation in those taking the tricyclic compared with the SSRI, but 9.4 times greater risk of suicidal ideation getting worse during treatment.

The difference could be due to nortriptyline being less effective at the low mood components of depression say the authors.

Their data suggests suicidal ideation was at its highest five weeks after the start of treatment and remind GPs to stay alert to suicidal ideation beyond the initial weeks of antidepressant treatment, says lead researcher Dr Nader Perroud of the Institute of Psychiatry said.

BMC Medicine 2009, 7:60 published online October 15, 2009

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