Amitriptyline is the most useful of a class of drugs known as tricyclic antidepressants (TCAs). These drugs can be lethal if taken in the right way.
These drugs date back to the early ‘60s where they established themselves as useful antidepressants. However their narrow therapeutic margin (the dose needed for therapy as an antide- pressant and that which is toxic is close) meant that there were dangers in prescribing these drugs, especially to depressed people, from either accidental or intentional overdose.
Their implication in a large number of deaths from overdose meant that other classes of safer antidepressants such as the seratonin re-uptake inhibitors (SSRI) like fluoxetine (Prozac) found favour and largely displaced the TCAs.
They have undergone something of a resurgence in recent years for the treatment of intractable neuropathic pain (such as trigeminal neuralgia) and migraine.
Using Tricylics to Die
The drugs have several characteristics that make them useful as reliable and lethal drugs. In particular they exhibit cardiotoxic and central nervous system (CNS) effects. CNS symptoms in- clude sedation and coma, but it is the cardiotoxic effects that reduce cardiac output, lower blood pressure and disrupt car- diac rhythm that bring about death.