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To the Editor: Dr Jick and colleagues¹ reported that the risk of suicidal behavior after initiating antidepressant treatment is similar among users of amitriptyline, fluoxetine, and paroxetine compared with the risk among users of dothiepin. This finding is relevant in countries where dothiepin is a reference antidepressant, such as the United Kingdom, but is less helpful where this agent has never been licensed, such as Italy and the United States.

In these and other countries, amitriptyline and other nondothiepin tricyclic antidepressants had been considered the standard treatment for depression, both in clinical practice and in experimental studies.² Newer antidepressants are now available, and a crucial question is whether suicidal behavior is increased in users of selective serotonin reuptake inhibitors compared with users of amitriptyline or other reference tricyclic antidepressants. Although Jick and colleagues did not address this issue, Table 3 in their article raises a question of a difference between . . . [Full Text of this Article]

Corrado Barbui, MD
corrado.barbui@univr.it
Department of Medicine and Public Health
Section of Psychiatry and Clinical Psychology
University of Verona
Verona, Italy

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