Are Tricyclics bad?

[MyNameIsTerry]

Why do Tricyclics have such a bad reputation?

Sorry for how your thread has gone, Pierre. Bumping back to this in the hope we can get back on topic.

[KK77]

Sorry for how your thread has gone, Pierre. Bumping back to this in the hope we can get back on topic.

You have some feckin' nerve Tim

[lliiaamm0099]

Are you aware of this study?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862059/

TCA's may be more toxic but it's far from unheard of that other classes have caused poisoning and death.

That's just a small number of hospitals.

Is it also worth noting the even higher rates (I'm assuming here, not checked the figures) for other drugs such as analgesics, paracetamol, etc.

That study appears to be carried out in England and Wales alone, I live, studied and work in Scotland so there is probably quite a difference in what has been prescribed in England and Wales compared to Scotland. I was also stating that I have never carried out a post mortem were the single cause of death has been a result of an SSRI/SNRI and even still to this day as a neurologist I still haven't come across it personally unless the person has added other serotonergic drugs which could have lead to serotonin toxicity (serotonin syndrome) but that could be easy to identify as it usually resembles delirium/mania. Also this study talked about individual toxicity of specific drugs but it didn't talk about the people who took them, for example there is no mention of people who had personality disorders such as borderline personality disorder.

[KK77]

That study appears to be carried out in England and Wales alone, I live, studied and work in Scotland so there is probably quite a difference in what has been prescribed in England and Wales compared to Scotland. I was also stating that I have never carried out a post mortem were the single cause of death has been a result of an SSRI/SNRI and even still to this day as a neurologist I still haven't come across it personally unless the person has added other serotonergic drugs which could have lead to serotonin toxicity (serotonin syndrome) but that could be easy to identify as it usually resembles delirium/mania. Also this study talked about individual toxicity of specific drugs but it didn't talk about the people who took them, for example there is no mention of people who had personality disorders such as borderline personality disorder.

Thanks for your input Liam. So would you say my answer below to the OP's question of Are Tricyclics bad? was a reasonable one?

Tricyclics are dangerous to OD on and at therapeutic levels have some unpleasant side effects, especially cognitive dysfunction. They're now mainly used in low doses for pain conditions and/or sleep disorders.

[Catherine S]

A qualified honest to God doctor of neurology...Boom! Liam, now you've come out, you do realise you're now going to be inundated with messages from all our ALS phobics don't you Take a deeeeep breath lol! Great to meet you and thanks for your 'professional' knowledge here.

And for any doubters, I'd say this man is the real thing because he talks about doing his bit in the morgue. If a person was only pretending to be a neurologist, they probably wouldn't give that side of it a thought, they'd go for the brain surgery angle just to impress everybody.

[lliiaamm0099]

Thanks for your input Liam. So would you say my answer below to the OP's question of Are Tricyclics bad? was a reasonable one?

I would agree that they are dangerous to overdose on, that study also verifies that they are the most dangerous group to overdose on. And you are right about the cognitive effects too, most Tricyclics antagonise histamine in the brain which can make thinking a bit more clouded and also can impair skilled tasks. Their antagonism of acetylcholine is perhaps their most worrying factor as drugs that antagonise these receptors used to be referred to as "deliriants" as they cause confusion and people become disorientated. That is why they shouldn't be prescribed to elderly people especially those over 70.

[MyNameIsTerry]

That study appears to be carried out in England and Wales alone, I live, studied and work in Scotland so there is probably quite a difference in what has been prescribed in England and Wales compared to Scotland. I was also stating that I have never carried out a post mortem were the single cause of death has been a result of an SSRI/SNRI and even still to this day as a neurologist I still haven't come across it personally unless the person has added other serotonergic drugs which could have lead to serotonin toxicity (serotonin syndrome) but that could be easy to identify as it usually resembles delirium/mania. Also this study talked about individual toxicity of specific drugs but it didn't talk about the people who took them, for example there is no mention of people who had personality disorders such as borderline personality disorder.

Regardless of the numbers, the point is that there are other antidepressant groups other than TCA's involved in suicide & poisoning. Is there empirical evidence to support this in the same way that it supports TCA's?

I'm pretty sure Ven, Mirt, Cit and the others are prescribed in Scotland so does it matter that much? It's very easy to check the prescribing volumes per our populations if needed.

The NHS certainly still use them though, with clear guidance to ensure safety.

[lliiaamm0099]

A qualified honest to God doctor of neurology...Boom! Liam, now you've come out, you do realise you're now going to be inundated with messages from all our ALS phobics don't you Take a deeeeep breath lol! Great to meet you and thanks for your 'professional' knowledge here.

Oh dear that's no good I do hope everyone here does realise the difference between neurology and psychiatry though. I specialise in conditions such as Parkinson's, dementia and as you say ALS. Although I do have the occasional patient with an uncommon disorder such as Tourette's syndrome so as for psychiatric advice I am probably not the best person on this forum, unless a person is being treated with an anticonvulsant for there anxiety which seems to be becoming more common with Pregabalin (Lyrica)

[KK77]

A qualified honest to God doctor of neurology...Boom! Liam, now you've come out, you do realise you're now going to be inundated with messages from all our ALS phobics don't you Take a deeeeep breath lol! Great to meet you and thanks for your 'professional' knowledge here.

And for any doubters, I'd say this man is the real thing because he talks about doing his bit in the morgue. If a person was only pretending to be a neurologist, they probably wouldn't give that side of it a thought, they'd go for the brain surgery angle just to impress everybody.

I'm not so sure. Some Doubting Tims will say I made him up just to prove KK right

[Catherine S]

I don't even pretend to understand how these meds work..or don't work, I only know its serious stuff, but just wanted to say you've been a breath of fresh air here tonight Liam. So thanks for that at least.

Carry On Doctor